. 
. 


183 


PRINCIPLES 


—OF- 


OSTEOPATHY: 


THIRD  EDITION. 

THOROUGHLY    REVISED, 


—BY— 


CHARLES  HAZZARD,  Fh.B,,  D,  O,, 

X 

Professor  of   Histology   and   Pathology,    1897-1898;    Professor 

of  Principles  of  Osteopathy,   1898-99,    in   the   American 

School  of  Osteopathy  and  Member  of  the  Staff  of 

Operators  in  the  A.  T.  Still  Infirmary, 

Kirksville,  Missouri. 


COPYRIGHTED  BY 

CHARLES    HAZZARD. 
1899. 


PREFACE  TO  THE  SECOND  EDITION. 


SINCE  the  first  appearance  of  this  work,  the  course  of  lectures  of 
which  the  first  edition  was  composed,  has  been  increased  in  number 
to  forty-four.  ' 

The  first  edition  contained  discussions  of  theory,  together  with  a 
review  of  the  human  body,  part  by  part,  with  indications  for  Osteo- 
pathic  examination  and  treatment  of  the  same.  The  second  edition  con- 
tains in  addition,  lectures  upon  specific  diseases,  with  descriptions  of 
the  Osteopathic  method  of  examination  and  treatment  of  the  same.  A 
limited  number  of  cases  has  been  thus  treated,  the  idea  being  not  to 
make  this  volume  a  Practice  of  Osteopathy,  but  to  show  the  method 
employed  in  diagnosis  and  treatment  of  the  several  different  classes  of 
cases  that  the  Osteopath  meets  in*  daily  practice.  For  example:  acute 
conditions,  such  as  typhoid  fever,  diarrhoea,  and  the  like,  and  on  the 
other  hand,  chronic  affections,  s.uch  as  spinal  curvatures,  constipation 
and  other  complaints  of  a  similar  nature,  have  been  dealt  with. 

To  this  there  have  been  added  a  few  lectures  upon  the  History  of 
Medicine,  Massage,  etc.,  in  order  that  the  student  may  know  the  prin- 
ciples of  such  systems,  and  learn  to  point  out  the  independence  of 
Osteopathy  from  them. 

CHARLES  HAZZARD. 

Kirksville,   Mo.,  Jan.   30,   1899. 


PREFACE  TO  THE  THIRD  EDITION. 


Owing  to  the  largely  increasing  interest  in  the  science  of  Osteopathy, 
its  great  success  as  a  healing  art,  the  opening  of  many  schools  for  the 
teaching  of  the  science,  and  the  flocking  to  these  schools  of  scores  and 
hundreds  of  young  men  and  women,  the  two  previous  editions  of  this  book 
— Principles  of  Osteopathy — have  been  quickly  exhausted.  Repeated 
orders  for  the  book  reaching  the  author  have  made  this  third  edition 
imperative  at  this  time.  The  revision  of  these  lectures  has  been  thorough ; 
the  lectures  on  the  History  of  Medicine  have  been  omitted,  as  not  being 
considered  germain  to  the  subject,  and  an  appendix  containing  observations 
and  facts  of  interest  and  value  to  the  profession  has  been  added. 

CHARLES  HAZZARD. 

Detroit,  Mich.,  Aug.   I,  1899. 


Principles  of  Osteopathy. 


I. 


LECTURE  1. 

I.     GENERAL  CONSIDERATIONS. 

Learn  to  treat  understandingly;  imitate  no  operator's  motions. 
Emerson  says,  "Imitation  is  suicide."  Take  for  instance  a  case  of  ery- 
sipelas. Should  the  operator  treat  about  the  sore  spots,  occurring 
usually  on  one  side  of  the  face  near  the  ear,  and  treat  there  alone,  with- 
out giving  attention  to  the  general  condition  of  the  patient,  taking  into 
account  the  affections  of  the  kidneys,  liver  and  other  organs  in  this 
trouble,  he  would  certainly  not  meet  with  success.  One  must  under- 
stand the  nature. of  the  disease  which  he  is  treating. 

Make  a  correct  diagnosis  of  the  case.  There  are  no  two  cases  alike/ 
You  cannot  take  it  for  granted  that  one  case  which  you  receive  today 
is  like  the  case  which  you  treated  yesterday.  Look  over  the  case  thor- 
oughly, making  an  individual  diagnosis  for  it;  likeness  and  unlikeness 
to  other  cases  are  incidental  only.  Make  no  diagnosis  by  telephone, 
as  I  knew  a  physician — a  fellow  townsman  of  mine — to  do  once.  Re- 
member that  a  young  doctor's  success  often  depends  upon  how  he  handles 
a  simple  case,  for  instance  headache,  which  although  not  always  simple, 
is  frequently  so.  Should  you  be  called  first  to  treat  a  case  of  headache, 
and  treat  it  successfully,  granting  it  was  a  simple  case,  your  future  suc- 
cess in  that  town  in  which  you  may  be  located,  may  depend  on  that. 
I  may  cite  here  an  incident  told  of  Thoreau.  It  is  said  that,  traveling  on 
a  train  one  day,  he  had  occasion  to  lower  the  car  window;  soon  thereafter 
he  was  accosted  /by  a  manufacturer  traveling  upon  the  same  train,  who 
said  that  he  had  noticed  his  delicate  manipulation  of  that  window  and 
upon  the  strength  of  that  observation  offered  him  a  position  in  his 
factory. 

Have  your  theories  but  stick  to  facts.  Remember  that  you  cannot 
always  treat  a  case  according  to  preconceived  theories — that  each  case 
is  peculiar  to  itself.  Huxley  says,  "Theories  do  not  alter  facts,  and  the 
universe  remains  unchanged,  even  though  texts  crumble." 


6  THE   SPINE. 

II.     GENERAL  CONSIDERATION  OF  THE  SPINE. 

ORIGIN  OF  THE  SPINAL  NERVES  (Holden)  :  "The  origin  of  the  eight 
cervical  nerves  corresponds  to  the  interval  between  the  occiput  and  the 
6th  cervical  spine. 

"The  origin  of  the  first  six  dorsal  nerves  corresponds  to  the  in- 
terval between  the  6th  cervical  and  the  4th  dorsal  spines. 

"The  origin  of  the  lower  six  dorsal  nerves  corresponds  to  the  inter- 
val between  the  4th  and  nth  dorsal  spines. 

"The  origin  of  the  five  lumbar  nerves  corresponds  to  the  interval 
between  the  nth  and  I2th  dorsal  spines. 

"The  origin  of  the  five  sacral  nerves  corresponds  to  the  last  dorsal 
and  first  lumbar  spines." 

LANDMARKS  ALONG  THE  SPINE:  Holden  instances  a  median  furrow 
caused  by  the  prominence  of  the  erectors  spinae,  which  extends  along  the 
spine  as  far  as  the  interval  between  the  5TH  lumbar  vertebra  and  the 
sacrum.  Hollows  upon  the  surface  correspond  generally  to  prominences 
of  the  skeleton,  and  vice  versa.  This  is  on  account  of  the  attachments 
by  tendons  to  prominent  skeletal  points.  Sharp  friction  will  redden  the 
spines  of  the  verterbrae  so  that  they  can  be  counted,  and  one  can  notice 
whether  they  are  in  line  or  not.  i 

The  level  of  the  3RD  dorsal  spine  is  the  level  of  the  root  of  the  spine  of 
the  scapula. 

The  level  of  the  7TH  dorsal  spine  corresponds  to  the  inferior  angle  of 
the  scapula. 

The  level  of  the  I2TH  dorsal  spine  corresponds  to  the  head  of  the  last 
rib. 

The  level  of  the  3RD  intercostal  space  corresponds  with  the  root  of 
the  spine  of  the  scapula. 

The  level  of  the  3RD  dorsal  spine  corresponds  with  the  3d  intercostal 
space. 

The  level  of  the  3RD  intercostal  space  corresponds  with  the  level  of  the 
right  and  left  bronchi,  the  right  being  nearer  the  posterior  chest  wall. 

The  following  is  a  convenient  method  for  ascertaining  the  position  of 
the  I2TH  dorsal  spine:  Have  patient  fold  his  arms  and  lean  forward,  thus 
bringing  the  spines  of  the  vertebrae  out  prominently;  then  the  lower 
border  of  the  trapezius  muscle  can  be  traced  to  the  I2th  dorsal  spine. 

The  KIDNEY  is  best  reached  by  pressure  below  the  level  of  the  last  rib 
at  the  outer  edge  of  the  erector  spine. 

The  TIP  of  the  crest  of  the  ilium  is  about  the  level  of  the  spine  of  the 
4th  lumbar  vertebra. 

The  ILIO-COSTAL  SPACE  extends  from  the  lower  border  of  the  I2th  rib 
to  the  crest  of  the  ilium,  varying  in  width  from  the  breadth  of  a  finger 


EXAMINATION    OF   THE    SPINE.  7 

to  that,  of  a  hand.  So  says  Holden.  I  would,  caution  you,  however,  in 
the  former  case  to  ascertain  carefully  whether  or  not  there  be  a  droop- 
ing of  the  ribs  and  alteration  of  the  chest  in  its  antero-posterior  diame- 
ter. Such  a  condition,  a  narrow  ilio-costal  space,  is  usually  accom- 
panied by  neurasthenia  and  kindred  affections. 

In  the  DEPRESSION  below  the  occiput  are  found  the  edge  of  the  trapezius 
muscle  and  the  upper  end  of  the  ligamentum  nuchae. 

The  2ND  cervical  spine  is  forked  and  rather  prominent.  The  3RD,  4x11 
and  STH  cervical  spines  are  not  usually  made  out,  as  they  recede  anteriorly 
from  the  surface.  The  6xn  and  7XH  (froniincns)  are  prominent.  The 
spines  of  the  dorsal  vertebrae  correspond  with  the  heads  of  the  ribs  next 
below,  e.  g. ;  the  4th  dorsal  spine  with  the  head  of  the  5th  rib.  But  the 
nth  and  I2th  dorsal  spines  correspond  with  the  heads  of  those  ribs. 

III.     ILLUSTRATIONS   UPON   THE   SPINE. 

In  LOCATING  THE  AXLAS,  it  is  felt  only  by  making  out  its  transverse 
processes,  which  are  readily  felt  on  each  side  between  the  mastoid  pro- 
cess and  the  angle  of  the  inferior  maxillary  bone;  the  normal  position 
being  about  midway  between  these  points  on  either  side.  Should  there 
be  a  deviation  from  the  normal,  either  to  one  side  or  the  other,  an- 
teriorly or  posteriorly,  or  a  twist  in  either  direction,  it  is  readily  made 
out  by  the  educated!  touch. 

PECULIAR  VERXEBRAE  are  found  along  the  spine,  viz. :  the  2nd,  6th  and 
7th  cervical,  I2th  dorsal  and  5th  lumbar.  The  2nd  cervical  is  noticeable 
because  of  being  slightly  prominent  and  bifid;  the  6th  and  7th  cervical 
because  of  slight  prominence;  the  I2th  dorsal  because  it  often  marks 
what  the  Osteopath  calls  a  "break,"  a  separation  of  the  spines  of  the 
vertebras  occurring  between  the  I2th  dorsal  and  ist  lumbar.  This  is  a 
point  of  importance.  The  same  is  the  case  with  the  5th  lumbar,  there 
often  being  a  break  between  its  spine  and  the  superior  crest  of  the 
sacrum. 

The  LIGAMENXUM  NUCHAE  is  of  great  importance  to  the  Osteopath. 
You  will  remember  that  it  extends  from  the  occipital  protuberance  to 
the  7th  cervical  spine.  You  must  learn  to  recognize  it  by  touch.  Fre- 
quently it  will  contract  and  is  the  sole  means  of  relieving  headache  when 
stretched. 

HOW  TO  EXAMINE  A  SPINE.* 

In  the  first  place,  notice  if  at  any  point  along  the  spinal  column  the 
spine  of  any  vertebra  is  DEVIAXED  LAXERALLY.  In  such  a  case  there  is  usually 


*See  Appendix  I. 


8  CENTERS   OF   THE   SYMPATHETIC. 

a  sore  spot  in  the  muscles  upon  the  side  of  the  spine  toward  which  it  is 
deviated.  In  the  neck  we  do  not  depend  upon  the  prominences  of  the 
spines  behind  to  diagnose  a  slip  in  the  vertebrae,  but  by  turning  the  head 
to  one  side,  thus  bringing  into  prominence  the  articular  processes  of  the 
vertebrae,  we  may  ascertain  whether  or  not  one  is  prominent  anteriorly, 
posteriorly,  or  laterally.  In  such  a  case  a  sore  spot  usually  is  found  at  the 
articular  process  of  the  vertebra.  SPINES  MAY  BE  SEPARATED  at  any  point 
along  the  column ;  you  may  find  the  spines  abnormally  far  apart.  We  occa- 
sionally find  what  is  designated  a  SMOOTH  SPINAL  COLUMN,  by  which  I 
mean  that  a  spinal  column  may  have  its  vertebrae  so  protected  by  the 
thickening  of  the  ligaments  or  other  structures  as  to  obviate  the  ordinary 
feeling  one  experiences  in  passing  the  hand  down  the  spine.  For  such  a 
condition  I  have  somewhat  arbitrarily  adopted  the  term,  "a  smooth  spinal 
column."  The  NATURAL  CURVES  OF  THE  SPINE  MAY  BE  CHANGED,  as  will 
readily  be  observed  in  practice.  I  do  not  speak  here  of  spinal  curvatures. 
not  at  all ;  but  frequently  a  slight,  or  it  may  be  a  marked,  deviation  from 
the  natural  curve  described  by  the  normal  spinal  column,  will  be  noticed. 
If  there  is  a  break,  LIGAMENTS  OFTEN  CAUSE  LESIONS  in  that  they  may,  by 
the  displacement  of  the  bony  parts  to  which  they  are  attached,  be  dragged 
across  some  important  structure,  such  as  a  nerve  or  blood  vessel,  com- 
pressing it  and  abridging  its  function. 

These  points  upon  how  to  examine  a  spine  will  be  continued  in  fur- 
ther lectures,  and  their  significance  to  the  Osteopath  be  fully  considered 
at  those  times. 


LECTURE  II. 

I.     CENTERS  OF  THE  SYMPATHETIC. 

These  centers  are  of  vast  importance  to  the  Osteopath.  Reasoning 
according  to  centers  is  frequently  with  him  going  from  effect  back  to 
cause,  and  from  periphery  back  to  center.  It  instances  one  of  his  modes 
of  thought,  and  to  acquire  this  habit  of  mind  is  frequently  the  basis  of 
our  professional  success.  There  is  a  given  definite  center  for  the  ac- 
tivities of  a  given  point  or  organ.  For  instance,  there  is  a  center  for 
which  we -work  to  affect  the  kidneys;  or,  we  may  say,  there  is  a  given 
definite  center  for  each  physiological  process.  As  for  instance,  there 
is  a  center  upon  which  we  work  to  affect  the  general  circulation.  In  the 
absence  of  a  discoverable  lesion,  which  frequently  occurs,  the  Osteo- 
path's work  must  be  largely  on  the  centers,  sometimes  entirely  so.  Even 
when  the  lesion  has  been  found  and  attended  to,  he  must  give  much 
attention  to  the  particular  center  governing  the  part  affected.  It  is 


SPINAL   CENTERS.  9 

going  back  to  first  principles.  The  following  points  have  been  gathered 
from  various  sources;  from  the  experience  of  operators,  from  lectures, 
from  books,  and  from  my  own  personal  experience.  I  speak  of  the  cen- 
ters, more  in  an  Osteopathic  than  in  a  purely  physiological  sense,  mean- 
ing that  point  along  the  spine  which  has  designated  itself  as  a  center 
in  response  to  the  work  upon  it;  results  justify  such  statements.  In 
-other  cases  these  so-called  centers  are  the  physiological  centers  indi- 
cated by  the  authorities. 

CENTERS  OF  THE  SYMPATHETIC: 

THIRD  CERVICAL  vertebra,  middle  of  neck.  Above  manipulate  upward ; 
below  manipulate  downward. 

THIRD,  fourth  and  fifth  cervical,  origin  of  the   PHRENIC — hiccoughs. 

THIRD,  fourth,  fifth  and  sixth,  .vaso-motors.  The  SUPERIOR  CERVICAL 
GANGLION  is  connected  with  the  first  to  fourth  cervical  nerves,  lying  oppo- 
site the  second  and  third  cervical  vertebrae.  The  MIDDLE  CERVICAL  GANG- 
LION is  connected  with  the  fifth  and  sixth  cervical  nerves,  lying  opposite 
the  sixth  and  seventh  cervical  vertebrae. 

The  point  between  the  first  and  second  dorsal  vertebras,  the  Senter 
to  the  LUNGS. 

First  rib  for  the  HEART. 

Between  second  and  third  dorsal,  CILIARY  CENTER,  and  recti  of  eye-ball. 

Between  fourth  and  fifth  dorsal  on  right  side  for  the  STOMACH  CENTER  ; 
on  the  left,  pneumogastric  for  the  PYLORIC  ORIFICE. 

Fifth  and  sixth  dorsal,  VASO  MOTORS  to  the  arm. 

Fifth,  sixth,  seventh  and  eighth  dorsal,  GREAT  SPLANCHNICS. 

Eighth  dorsal,  center  for  CHILLS. 

Ninth,  tenth  and  eleventh  dorsal,  SMALL  SPLANCHNICS. 

Twelfth,  SMALLEST  splanchnic. 

From  a  point  between  the  seventh  cervical  and  first  dorsal  to  a  point 
between  the  eighth  and  ninth  dorsal,  the  center  for  the  anterior  dorsal 
branches,  which  convey  dorsal  branches  to  PULMONARY  PLEXUS.  The  pos- 
terior pulmonary  plexus  connects  with  the  second,  third  and  fourth 
ganglia  of  the  sympathetic.  The  anterior  pulmonary  plexus  is  from  the 
pneumogastric  and  sympathetics.  VASO  MOTORS  TO  THE  LUNGS  have  been 
found  in  the  dog  from  the  second  to  the  seventh  dorsal.  This  corres- 
ponds to  the  centers  upon  which  we  work  in  man  to  reach  the  lungs. 

Second  lumbar  vertebrae,  center  for  PARTURITION,  MICTURITION,  DEFECA- 
TION. 

Third  lumbar,  COELIAC  AXIS. 

Point  between  fourth  and  fifth  lumbar  vertebrae,  DEFECATION. 

Fifth  lumbar,  center  for  HYPOGASTRIC  PLEXUS. 

From  a  point  between  the  second  and  third  sacral  to  a  point  between 
the  fourth  and  fifth  sacral,  center  for  the  NECK  OF  THE  BLADDER. 


10  SPINAL  CENTERS. 

Fourth  sacral,  center  to  RELAX  VAGINA. 

Fourth  sacral,  SPHINCTER  ANI  (the  latter  two  are  spinal  branches). 

The  term  "CERVICAL  BRAIN"  has  been  applied  by  Dr.  Still  to  the  region 
lying  between  the  first  cervical  vertebra  and  the  fourth  dorsal  vertebra. 
The  term  "ABDOMINAL  BRAIN"  has  been  applied  by  him  to  the  region  lying 
between  the  first  dorsal  and  third  lumbar  vertebrae,  "PELVIC  BRAIN,"  to  that 
region  lying  between  the  tenth  dorsal  and  fifth  lumbar  vertebne. 

Other  centers  of  the  sympathetic  are  as  follows: 

SENSATION,  atlas  to  fourth  dorsal. 

MOTION,  fourth  dorsal  to  sixth  dorsal. 

NUTRITION,  sixth  dorsal  to  coccyx. 

These  three  centers  are  spoken  of  by  Dr.  Still. 

CENTERS  IN  THE  MEDULLA  as  follows :  Cough,  sneeze,  vomit,  respira- 
tion, salivation,  phonation  and  deglutition,  renal  center,  center  for 
spasms. 

VASO  MOTOR  CENTERS  :    Medulla,  second  to  sixth  dorsal,  fifth  lumbar. 

CILIO-SPINAL  center,  fourth  cervical  to  the  second  or  fourth  dorsal. 

HEART  center,  in  the  corpora  striata ;  first  rib ;  first,  second,  third, 
fourth  and  fifth  dorsal  vertebrae. 

CERVIX  UTERI,  ninth  dorsal. 

BLOOD  SUPPLY  TO  OVARIES,  eleventh  dorsal. 

UTERUS,  second  lumbar,  secpnd  and  third  sacral  vertebrae,  also  hypo- 
gastric  plexus  by  the  lower  dorsal  and  four  upper  lumbar  nerves,  and 
through  the  splanchnics. 

VASO  MOTORS  OF  THE  HEAD:  The  eye,  ear,  salivary  glands,  tongue, 
brain,  etc.,  are  all  reached  at  the  superior  cervical  ganglion.  Here  also 
a  general  vaso-motor  effect  to  the  body  is  claimd.  Vaso  constrictors  for 
the  head  are  said  to  exist  at  the  fifth  and  sixth  dorsal  vertebrae.  Stimula- 
tion of  the  superior  cervical  ganglion  has  a  vaso  constrfctpr  effect  upon 
the  vessels  of  the  retina,  probably  through  its  ascending  branch  and  its 
connection  with  the  fifth  nerve. 

The  LUNGS,  second  to  seventh  dorsal  vertebrae. 

JEJUNUM,  first  to  fifth  dorsal  vertebrae. 

SMALL  INTESTINE,  above  first  lumbar. 

LARGE  INTESTINE,  first  to  fourth  lumbar. 

LIVER,  the  splanchnics,  vagi,  and  inferior  cervical  ganglion. 

KIDNEYS,  the  sixth  dorsal,  second  lumbar,  renal  splanchnics  and 
superior  cervical  ganglion. 

SPLEEN,  splanchnics  on  the  left  side;  eighth  to  twelfth  dorsal. 

LOWER  LIMBS,  second  dorsal  down. 

CIRCULATION,  superficial  fascia  (the  second  dorsal  for  the  upper  part 
of  the  body,  the  fifth  lumbar  for  the  lower  part). 

VALVES  OF  THE  HEART,  second  to  fourth  dorsal. 


CONSIDERATION   OF   THE   SYMPATHETIC.  11 

RHYTHM  OF  THE  HEART,  third  and  fourth  cervical. 

The  GENITO-SPINAL  center  and  lower  hypogastric  plexus  and  plexus  to 
intestinal  canal,  bladder  and  vasa  deferentia,  at  the  fourth  and  fifth 
lumbar. 

BOWELS  (peristalsis),  ninth,  tenth  and  especially  the  eleventh  dorsal. 

LARNYX,  first,  second  and  third  cervical. 

III.  HOW  TO  EXAMINE  A  SPINE.— (Continued.)— LOOK  FOR 
THE  LESION  always.  It  may  be  high  above  or  much  below  the  usual  center. 
For  instance,  we  may  work  as  high  as  the  lower  dorsal  for  sciatica,  its 
center  being  in  the  sacral  plexus.  This  lesion  may  be  in  the  nature  of  a 
strain,  congested  muscle,  a  dragging  of  ligaments,  or  a  tightening  of  the 
ligaments,  thus  drawing  the  vertebrae  together.  It  may  be  in  the  nature 
of  a  sprain  or  break.  It  may  even  be  undiscoverable.  But  remember 
that  your  duty  is  not  done  until  you  have  thoroughly  looked  for  the 
lesion.  A  CONGESTION  OF  THE  SPINAL  MUSCLES  is  often  noticed  on  examina- 
tion; it  may  be  of  the  superficial  muscles  or  of  the  deep  muscles;  it  may- 
be primary  or  secondary.  By  PRIMARY,  I  mean  a  congestion  of  the 
muscles  set  up  by  some  direct  effect  upon  them,  e.  g. ;  the  effects  of  a 
draft  or  a  blow.  This  congestion  involves  the  peripheral  termination  of 
the  spinal  nerves,  acting  through  them  and  through  their  sympathetic 
connections  to  affect  some  internal  viscus.  By  SECONDARY,  I  mean  the 
reverse,  for  example,  the  stomach  may  be  affected,  and  the  affects  may 
be  transmitted  over  the  solar  plexus,  back  along  the  splanchnics,  thence 
to  the  spinal  nerves  with  which  the  splanchnics  are  connected,  thence 
back  over  the  peripheral  terminations  of  these  nerves  to  the  skin  and 
muscles  of  the  back.  You  may,  in  your  examination  of  the  spine,  find 
that  it  is  frequently  RIGID,  not  pliant;  on  the  other  hand,  you  may  find 
that  it  is  quite  RELAXED;  abnormally  mobile. 


LECTURE   III. 

1.  FURTHER  CONSIDERATION  OF  THE  SYMPATHETIC 
SYSTEM: — I  have  already  spoken  of  the  importance  that  we  as  Osteo- 
paths attach  to  centers,  especially  to  those  centers  which  I  have  given 
you  along  the  spine.  The  theory  of  our  work  upon  them  and  their  signi- 
ficance in  connection  with  disease  we  shall  take  up  later.  I  may,  in 
passing,  say  that  they  are  one  of  the  most  important  things  by  which  the 
Osteopath  has  to  work.  The  same  is  true  of  the  sympathetic  system  in 
general.  The  general  anatomy  of  the  sympathetic  system  is  doubtless 
already  known  to  you,  but  there  are  points  which  I  wish  to  recall  to  your 
attention  and  cite  you  their  significance  from  our  standpoint. 


12  CONSIDERATION    OF  THE   SYMPATHETIC. 

POINTS  FROM  QUAIN :— The  sympathetics  are  connected  with  the 
spinal  nerves  by  white  and  gray  rami  communicantes.  The  white  are  med- 
ullated  and  pass  from  the  spinal  nerves  to  the  sympathetic  ganglia.  Some 
white  fibres  pass  from  the  ganglion  to  the  efferent  ramus.  Some  end  in 
the  ganglia;  they  may  ascend  or  descend  in  the  sympathetic  cordl  to 
higher  or  lower  ganglia,  thus  connecting  with  several,  and  being  in  this 
manner  widely  distributed  to  the  sympathetics.  The  gray  rami  com- 
municantes are  non-medullated,  or  pale.  They  pass  from  the  sympathetic 
ganglia  back  to  the  spinal  nerves,  the  reverse  of  the  white.  They  arise 
from  cells  in  the  sympathetic  ganglia.  They  may,  rarely  however,  run 
in  the  sympathetic  cord  to  another  ganglion,  and  then  emerge  to  take 
their  course  to  the  spinal  nerves.  They  enter  the  anterior  primary 
division  of  the  spinal  nerves,  divide  to  send  some  fibres  centrally  toward 
the  cord,  some  peripherally  through  the  spinal  nerves  to  the  general 
system.  Those  gray  fibres  of  the  sympathetic  which  pass  CENTRALLY  join 
in  part  a  recurrent  branch  of  the  spinal  nerve  and  with  it  run  to  supply 
the  vertebrae,  the  dura  mater,  the  ligaments  and  blood  vessels  of  the 
spinal  canal.  Other  filaments  pass  over  the  bodies  of  the  vertebra  and 
supply  the  intercostal  and  lumbar  arteries  and  veins,  ligaments  and  bones. 
Thus,  the  central  distribution  of  the  sympathetic  nerve  is  of  great  import- 
ance to  the  Osteopath  in  his  work  of  building  up  a  weak  or  defective 
spine,  and  helps  to  explain  the  wonderful  results  he  obtains  in  that 
department  of  his  work.  Those  sympathetic  fibres  which  pass  DISTALLY 
in  the  anterior  and  posterior  primary  divisions  of  the  spinal  nerves  supply 
the  blood  vessels  of  the  body  walls  and  muscles  with  vaso-motor  fibres, 
the  sweat  glands  of  the  skin  with  secretory  fibres,  and  the  hairs  with  pilo- 
motor  fibres. 

Here  again  the  sympathetic  system  becomes  significant  from  the 
Osteopathic  point  of  view,  and  aids  in  explaining  the  reasons  for  the 
immediate  results  attained  in  keeping  the  skin,  the  so-called  second  lung, 
and  superficial  fascia  in  good  working  order.  It  is  important  in  cases  of 
blood  and  skin  diseases  and  in  fevers.  The  centers  of  the  superficial 
fascia,  you  will  remember,  are  the  superior  cervical  ganglia,  the  2d  dorsal 
and  the  5th  lumbar.  Doctor  Still,  who  in  the  past  few  months  has  been 
making  special  studies  upon  this  subject,  attaches  great  importance  to 
the  superficial  fascia. 

Of  equal  importance,  finally,  are  the  VISCERAL  DISTRIBUTIONS  of  the 
sympathetic  nerves,  there  being  efferent  branches  running  forward  from 
the  sympathetic  ganglion  to  the  great  pre-vertebral  plexuses,  the  cardiac, 
solar,  and  hypogastric,  so-called  primary  plexuses,  and  their  secondary 
plexuses,  e.  g. ;  the  phrenic,  renal,  spermatic,  coeliac,  superior  and  inferior 
mesentric,  aortic,  hemorrhoidal.  vesical,  etc.  Their  importance  to  the 
Osteopath  lies  in  the  fact  that  through  them  he  may  regulate  the  actions 


SYMPATHETIC   SYSTEM.      LANDMARKS.  13 

of  the  internal  viscera  to  a  wonderful  degree.  Thus  we  stumble  onto  the 
paradox  that  a  man's  internal,  organic  life  may  come  under  the  control 
of  another  to  a  greater  or  less  extent. 

Some  gray  fibres  pass  from  the  ganglia  out  over  the  efferent  rami. 
I  have  placed  here  on  the  board  a  diagram  from  Quain  in  which  you  note 
illustrated  the  points  which  I  have  brought  out  concerning  the  gray  and 
white  rami  communicantes  and  their  connections  with  the  anterior  and 
posterior  divisions  of  the  spinal  nerves,  their  course  toward  the  cord  and 
also  the  efferent  rami  running  outward  to  the  great  prevertebral  plexuses. 
The  MEDULLATED  FIBRES,  that  is,  those  of  the  white  rami,  may  be,  ist, 
sensory,  running  from  the  posterior  root  of  the  spinal  nerve ;  2nd,  vaso 
and  viscera-constrictors,  from  the  Qth,  loth  and  nth  cranial  nerves,  and 
from  the  anterior  and  posterior  roots  of  the  spinal  nerves,  ending  in  the 
sympathetic  ganglion,  whence  their  action  is  carried  out  through  pale 
fibres  rising  from  cells  in  the  ganglia.  These  fibres  thus  have  become  de- 
medullated  by  passing  through  the  sympathetic  ganglia.  They  may  be,  3rd. 
vaso  dilators  and  viscera  inhibitors  from  the  anterior  spinal  roots,  and 
from  the  9th,  loth  and  nth  cranial  nerves,  passing  through  the  sympa- 
thetic ganglia,  not  connecting  with  any  nerve  cells  therein,  and  reaching 
the  organ  they  supply  as  medullated  nerves. 

II.  LANDMARKS.  A  tabular  plan  of  the  parts  opposite  the  spines 
of  the  vertebrae.  {After  Holden.)  Opposite  7th  cervical  spine,  apex  of 
lung,  higher  in  females. 

Opposite  3rd  dorsal,  aorta  reaches  spine,  apex  of  lower  lobe  of  lung, 
angle  of  bifurcation  of  trachea. 

Opposite  4th  dorsal  spine,  aortic  arch  ends;  upper  level  of  heart. 

Opposite  8th  dorsal  spine,  lower  level  of  heart;  central  tendon  of  di- 
aphragm. 

Opposite  Qth  dorsal  spine,  oesophagus  and  vena  cava  perforate  diaph- 
ragm; upper  edge  of  spleen. 

Opposite  loth  dorsal  spine,  lower  edge  of  lung;  liver  comes  to  the  sur- 
face posteriorly;  cardiac  orifice  of  stomach. 

Opposite  nth  dorsal  spine,  lower  edge  of  spleen;  supia-renal  capsule. 

Opposite  I2th  dorsal  spine,  lowest  part  of  pleura;  aorta  perforates  di- 
aphragm; pylorus. 

Opposite  ist  lumbar  spine,  renal  artery;  pelvis  of  kidney. 

Opposite  2nd  lumbar  spine,  termination  of  spinal  cord;  pancreas ;  duo- 
denum just  below;  receptaculum  chyli. 

Opposite  3rd  lumbar  spine,  umbilicus;  lower  border  of  kidney. 

Opposite  4th  lumbar  spine,  division  of  aorta;  highest  part  of  ilium. 

APEX  OF  LUNG  is  most  liable  to  disease ;  may  be  examined  by  percus- 
sion at  external  end  of  clavicle. 


14  EXAMINATION    OF   THE   SPINE. 

Angle  of  BIFURCATION  OF  TRACHEA  is  in  some  cases  opposite  the  4th 
dorsal  spine.  This  angle  corresponds  in  front  with  the  junction  of  the 
first  and  second  parts  of  the  sternum. .  As  to  the  KIDNEY,  its  upper  .bor- 
der may  be  as  high  as  the  level  of  the  space  between  the  nth  and  i2th 
dorsal  spines.  Its  lower  bord'er  may  extend  as  low  as  the  3rd  lumbar 
spine. 

III.  HOW  TO  EXAMINE  A  SPINE.—  (Continued.)—  I  spoke  in  a 
previous  lecture  of  variations  of  curves  of  the  spine  from  the  normal.  A 
few  more  words  concerning  this.  There  may  come  to  your  notice  in  your 
examination  of  a  spine  a  FLATTENING  between  the  shoulders ;  on  the  con- 
trary, the  tendency  there  may  be  decidedly  POSTERIOR.  The  same  condition 
may  prevail  immediately  below  the  shoulders  about  the  middle  of  the  back. 
You  may  have  a  posterior  flattening  of  the  LUMBAR  region,  which  naturally, 
as  you  know,  is  curved  anteriorly.  But,  on  the  other  hand,  you  may  have 
too  pronounced  a  tendency  anteriorly  in  this  region.  Again,  you  may 
have  all  of  the  normal  curves  of  the  spine  lessened,  leaving  what  we  de- 
scribe as  a  STRAIGHT  SPINE.  You  will  readily  see  that  in  such  a  condition 
the  whole  equilibrium  of  the  body  is  more  or  less  disturbed.  You  may 
find  the  SACRUM  itself  too  prominent  posteriorly,  or  too  flat,  thus  in- 
crejasing  or  diminishing  the  antero-posterior  diameter  of  the  pelvis. 
Finally,  you  may  find  that  the  COCCYX  has  been  bent  to  one  side,  in  which 
case  it:  may  be  the  cause  of  piles;  it  may  be  bent  forward,  as  frequently 
you  will  find,  from  horseback  riding,  etc.  In  such  a  case  it  may  be- 
come a  mechanical  impediment  to  the  passage  of  fecal  matter,  causing 
constipation.  In  calling  your  attention  to  these  points  in  how  to  ex- 
amine a  spine,  I  have  left  aside  the  subject  of  their  significance.  That 
subject  will  be  fully  considered  in  later  lectures. 


LECTURE   IV. 

HOW  TO  EXAMINE  A  SPINE   (Concluded.) 

There,  are  a  few  more  points  regarding  the  abnormal  curves  of  the 
spine,  which  I  think  will  be  useful  to  you,  flattening  between  the  shoul- 
ders or  posterior  tendency  there,  and  the  posterior  tendency  that  we 
frequently  meet  along  the  lumbar  region  or  flattening  there.  Recall  the 
different  positions  of  the  coccyx  that  we  find  upon  examination,  and 
the  different  positions  in  which  we  find  the  sacrum  itself.  There  may 
be  considerable  variation  in  the  curves  of  the  spine,  so  that  you  may 
have  quite  a  straight  spine  by  the  time  you  have  looked  over  all  the 
points.  Hence  the  natural  equilibrium  may  be  destroyed. 


SIGNIFICANCE   IN    SPINAL   EXAMINATION.  15 

There  is  one  other  point  which  you  will  probably  find,  and  that  is 
that  a  vertebra  may  not  only  be  slipped  from  side  to  side,  but  by  fol- 
lowing the  curve  along  the  spine  we  may  come  to  a  vertebra  extending 
backward — not  only  one  or  two,  but  several  may  be  DISPLACED  BACKWARD  ; 
or  you  may  find  a  single  one  displaced  ANTERIORLY.  I  treated  a  case  in 
which  one  of  the  dorsal  vertebrae  was  pushed  anteriorly,  effecting  the 
kidneys.  Thus  lesion  generally  affects  the  center  near  which  it  occurs. 

Hilton  says  that  frequently  he  has  found  that  a  PRESSURE  OF  THE  HEAD 
DOWNWARD  on  the  spine,  and  then  rotation  from  side  to  side  will  cause  a 
sensation  of  pain  in  the  cervical  region,  and  will  be  evidence  of  disease 
there,  when  one  has  not  been  able  to  find  it  by  other  diagnosis.  He  has 
found  that  the  general  symptoms  justified  his  locating  the  disease  in  the 
upper  cervical  vertebrae. 

There  is  another  point  that  is  of  importance  to  you,  and  you  should 
understand  it.  As  you  work  along  the  spine  you  may  hear  certain 
popping  noises.  You  will  find  them  all  along  the  spine,  sometimes  on 
one  side,  sometimes  on  the  other.  Also  when  you  are  working  on  the 
neck,  you  may  get  a  click.  The  patient  may  hear  it  when  he  is  turning 
his  head  from  side  to  side.  Now  the  reason  as  to  why  you  hear  these 
noises  along  the  spine  is  explained  differently  in  the  different  regions. 
In  the  dorsal  Tegion  there  are  three  things  that  may  move.  The  whole 
vertebra  may  be  moved);  there  is  inter-vertebral  motion,  but  we  do  not 
get  many  of  these  noises  from  that  cause,  on  account  of  the  way  they  are 
bound  together,  being  connected  by  inter-vertebral  discs,  with  no  syno- 
vial  membrane.  The  second  place  in  which  you  may  get  motion  is  be- 
tween the  head  of  the  rib  and  its  articulation  with  the  bodies  of  the  ver- 
tebrae and  the  inter-vertebral  substances.  Then  in  the  third  place,  you 
have  motion  at  the  tuberosities  of  the  ribs,  where  they  articulate  with 
the  transverse  processes  of  the  next  vertebra  (below.  In  the  neck  the 
only  place  you  are  liable  to  get  a  click  is  between  the  articular  processes 
of  the  vertebrae.  These  noises  in  the  spine  are  of  much  significance, 
you  will  meet  them  and  must  understand  them. 

II.     OSTEOPATHIC  SIGNIFICANCE  OF   POINTS   OBSERVED 
IN   EXAMINATION  OF  THE  SPINE. 

After  understanding  fully  how  to  examine  the  spine,  your  next  ques- 
tion naturally  is,  "When  I  have  found  these  things  along  the  spine, 
what  is  their  significance?"  If  we  do  not  know  what  they  mean  they 
are  useless  to  us.  When  once  you  know  the  results  of  certain  lesions  it 
does  not  take  you  long  to  find  the  lesion.  I  have  therefore  for  the  pres- 
ent dropped  the  subject  of  the  sympathetic  nerve,  and  have  decided  to 
devote  one  or  two  lectures  to  the  general  consideration  of  the 


16  METHODS   OF   OSTEOPATHIC   REASONING. 

OSTEOPATHIC  SIGNIFICANCE  of  the  points  which  we  find  in  our  examination 
of  the  spine.  Remember  that  this  cannot  be  given  to  you  in  full  by  lec- 
tures, and  that  you  will  recognize  the  full  significance  only  in  your  prac- 
tice. I  can  make  it  plainer  later  when  we  take  up  particular  cases.  What 
I  want  to  do  is  to  show  you  the  significance  of  certain  points,  and  to 
get  you  into  the  habit  of  osteopathic  reasoning — to  show  you  how  we 
look  at  these  things,  and  the  process  of  thought  followed. 

The  first  point,  then,  is  as  follows :  In  general,  a  LESION  along  the 
spine,  whatever  its  character,  AFFECTS  THE  CENTER  at  which  it  occurs,  and 
thus  may  affect  cerebro-spinal  life  or  sympathetic  life,  either  or  both;  the 
former,  if  it  is  more  superficial,  in  general,  and  the  latter  if  it  is  deeper, 
in  general.  As  to  the  character  of  the  leison,  it  may  be  of  any  form 
found  in  the  examination  of  the  spine.  As  to  locality,  it  may  be 
either  superficial  or  deep.  You  may  find  along  between,  the  shoulders 
a  flattening,  which  may  extend  as  low  as  the  8th  dorsal,  and  interfere 
with  the  centers  of  the  stomach.  If  it  be  serious  in  character  it  will  ex- 
tend deep  enough  to  affect  the  sympathetics,  and  thus  organic  life,  and 
you  will  probably  have  stomach  trouble.  If  it  is  not  deep  enough  to 
affect  the  sympathetic  life,  it  may  affect  the  cerebro-spinal  life  and1  you 
will  have  a  lame  back;  or  if  it  is  in  the  region  of  the  6th  or  /th  dorsal, 
pains  may  run  around  the  ribs  and  meet  over  the  pit  of  the  stomach. 
The  character  of  the  injury  may  be  such  that  it  affects  deeper  structures, 
or  it  may  have  a  more  superficial  effect. 

The  next  point  in  osteopathic  reasoning  is  the  consideration  of  the 
amount  or  INTENSITY  OF  LIFE  displayed  in  any  given  condition.  This  is  an 
important  point,  and  perhaps  not  clearly  expressed,  but  I  will  try  to 
make  it  plain  to  you.  Ycu  may  have  a  rigid  spine,  or  you  may  have  a 
relaxed  spine.  Now,  in  general,  the  process  of  reasoning  which  the  os- 
teopath uses  is  about  as  follows:  The  fact  that  the  spine  is  relaxed  shows 
a  lack  of  nerve  force,  a  lack  of  life  there.  On  the  other  hand,  if  there 
is  great  tension  along  the  spine,  the  spine  is  closely  bound  down  and 
held  together  by  the  ligaments,  so  that  you  have  a  rigid  spine  with  little 
motion,  the  reasoning  would  be  that  there  had  been  an  injury  to  the 
spine  that  had  resulted'  in  directing  too  much  nerve  force  to  that  part 
of  the  body  for  a  shorter  or  longer  period  of  time,  which  resulted  in 
throwing  too  much  food  supply  there,  causing  a  thickening  of  the  liga- 
ments binding  the  vertebise  together.  Collaterally,  when  too  much  life 
was  thrown  to  that  part  it  was  robbing  some  other  point. 

Take  several  illustrations  to  make  this  clear:  You  may  have  a  ten- 
sion in  the  spinal  muscles.  It  may  seem  queer  to  you,  or  to  your  pa- 
tients, for  you  to  tell  them  that  a  muscle  is  contracted,  congested  or 
drawn,  and  has  remained!  that  way.  It  is  hard  to  believe,  but  such  is 
the  fact.  What  does  such  a  condition  argue  to  your  mind?  Simply  that 


SIGNIFICANCE   IN    SPINAL   EXAMINATION.  I/ 

there  is  too  great  an  amount  of  nerve  force  there,  which,  reacting  upon 
the  muscles,  causes  them  to  contract.  In  that  case  your  nervous  force 
is  in  the  nature  of  a  stimulation  to  those  terminal  sensory  nerves.  On 
the  other  hand,  it  may  be  secondary  from  the  condition  of  an  internal 
viscus.  There  may  be  some  visceral  disease,  say  stomach  trouble,  which 
would  be  reflected  from  the  solar  plexus  out  along  the  splanchnics  to 
the  spinal  nerves,  and  through  the  spinal  nerves  to  their  destination. 
There  may  be  a  misdirection  of  nerve  force,  which  is  sent  to  the  spinal 
muscles,  and  you  have  too  great  a  supply  of  nerve  force  along  the  spine. 
We  reason  according  to  the  amount  of  nerve  force  sent  to  these  points. 
Again,  when  you  make  a  digital  examination  of  the  rectum,  you  may 
find  that  there  is  some  irritation  which  acts  in  the  nature  of  a  stimulation 
to  the  nerve  force  which  supplies  that  rectal  sphincter,  and  is  causing 
it  to  contract.  On  the  other  hand,  you  will  find  in  some  examinations 
that  there  is  no  force  whatever  put  forth,  the  sphincter  is  relaxed,  and 
in  such  -cases  it  is  very  likely  that  the  patient  is  suffering  from  incon- 
tinence of  fecal  matter.  In  the  one  case  there  is  too  much  nerve  life,  in 
the  other  too  little.  This  may  also  result  from  visceral  troubles.  In  a 
case  of  diarrhoea  the  Osteopath  first  examines  to  find  some  lesion  along 
the  spine  at  the  9th,  loth,  or  nth  dorsal,  causing  too  much  nerve  force 
to  be  directed  from  the  sympathetic  system  to  the  intestine,  so  that  there 
is  too  rapid  peristalsis  and  also  too  great  a  secretion  of  watery  matter. 
There  is  too  much  nerve  life  there,  or  there  could  not  be  -too  much  mo- 
tion. On  the  other  hand,  in  constipation,  either  something  has  hap- 
pened to  deaden  the  nerve  force,  or  to  disseminate  nerve  force  to  other 
parts  of  the  body,  so  that  you  have  too  little  left.  You  have  not  enough 
energy  to  pass  the  fecal  matter  along  its  course,  and  the  result  is  a  case 
of  constipation.  This  is  not  a  full  explanation  of  all  these  cases,  but  I 
simply  use  them  as  illustrations.  You  will  find  this  a  valuable  point  in 
Osteopathic  reasoning.  In  the  former  case  the  Osteopath  adopts  such 
measures  as  will  disseminate  the  nerve  force  and  equalize  it  throughout 
the  body.  In  the  latter  case  he  directs  his  attention  to  a  i.itional  means 
of  renewing  the  nerve  force  which  is  lacking  at  the  point  affected. 

When  you  find  upon  examination  that  the  SPINES  are  SEPARATED,  what 
is  your  conclusion?  Simply  that  some  lesion  has  caused  a  relaxation. 
There  is  too  little  life,  and  hence  a  separation.  This  may  impinge  upon 
the  nerve  centers  and  there  will  be  trouble  according  to  the  center  over 
which  the  lesion  has  occurred.  In  a  case  of  a  "smooth  spine,"  where 
every  vertebra  seems  to  be  drawn  down  close  to  its  fellow,  there  seems 
to  have  resulted  a  contraction  of  the  ligaments  connecting  them,  affecting 
almost  all  of  the  centers  along  the  spine  to  a  greater  or  less  degree; 
there  may  result  neurasthenia,  a  general  lack  of  nutrition,  general  eye 
troubles,  nervous  troubles,  circulatory  affections,  etc. 


18  SIGNIFICANCE    IN    SPINAL   EXAMINATION. 

A  SPINE  TWISTED  leads  us  to  look  at  the  center  which  is  affected.  This 
brings  us  to  the  tension  on  the  ligaments  which  I  have  mentioned. 
When  we  have  a  case  in  which  there  is  a  twist  of  the  vertebra,  we  reason 
from  the  position  of  parts  as  to  what  ligaments  are  affected.  Suppose, 
for  instance,  that  a  vertebra  is  twisted  so  that  a  spine  instead  of  being 
exactly  in  line,  is  turned  towards  the  right,  then  what  is  the  condition 
of  the  ligaments?  The  anterior  and  posterior  ligaments  along  the  bodies 
of  the  vertebra  will  be  obliquely  upon  a  tension,  the  supra-spinous  and 
inter-spinous  ligaments  will  also  t>e  upon  a  strain,  the  ligamentum  sub- 
flavum  on  the  left  side  will  be  tightened,  and  that  on  the  right  side 
tightened  also;  the  inter-transverse  ligaments  on  each  side  will  be  tight, 
and  extend,  one  forward  and  the  other  backward.  This  is  the  method 
of  reasoning  you  should  adopt,  and  you  should  reason  from  the  symp- 
toms as  to  what  nerves  are  affected.  You  will  find  that  the  ligaments 
may  draw  across  nerves  in  such  a  way  as  to  affect  nervous  life,  either 
spinal  alone  or  sympathetic  through  the  spinal. 

I  mentioned  along  the  spine  certain  peculiar  vertebrae.  In  regard  to 
the  SECOND  CERVICAL  VERTEBRA,  if  you  are  a  young  Osteopath  and  examining 
your  first  patient,  you  will  be  sure  to  find  something  wrong  with  that 
vertebra.  Bear  in  mind  that  it  is  not  like  the  others,  but  has  a  prominent 
forked  spine.  You  may  make  the  same  mistake  with  the  7TH  CERVICAL. 
You  should  acquaint  yourselves  with  these  natural  conditions,  so  that  you 
may  judge  correctly  as  to  any  change  from  the  normal  condition.  Then 
bear  in  mind  also  that  the  I2TH  DORSAL  and  the  5th  lumbar  are  very  apt 
to  be  points  of  mischief,  and  a  separation  is  very  likely  to  take  place  at 
those  points.  Between  the  5th  lumbar  and  the  sacrum  is  a  point  which 
is  frequently  affected  and  which  makes  a  great  deal  of  trouble.  The 
STH  LUMBAR  may  be  anterior  or  it  may  be  posterior,  and  in  such  a  case 
it  depends  upon  your  symptoms  as  to  how  you  will  diagnose  your  case. 
This  may  cause  trouble  with  the  viscera  supplied  by  the  sympathetic 
nerve,  there  may  be  uterine  trouble,  trouble  with  the  generative  organs 
of  either  sex,  paresis,  paralysis,  or  sciatica. 

In  these  VARIATIONS  FROM  THE  NORMAL  CURVES  of  the  spine,  in  general 
the  signification  to  the  Osteopath  is  as  follows:  If  there  is  a  flattening  or 
posterior  tendency  between  the  shoulders,  you  will  generally  find  that 
the  patient  has  heart  or  lung  trouble.  You  will  expect  to  find  some 
lesion  there  affecting  those  organs,  which  acts  directly  by  impinging 
upon  the  nerves  or  by  changing  the  position  of  the  ribs.  There  may  be 
a  change  in  the  first  or  second  rib,  causing  heart  trouble;  of  the  7th  rib, 
causing  asthma.  You  may  have  heart  or  lung  trouble  there,  or  if  it  is  as 
low  as  the  8th  dorsal  you  may  have  stomach  trouble,  or  there  may  be 
renal  trouble  caused  by  a  lesion  as  high  as  the  2nd  dorsal,  or  sciatica  as 
high  as  the  2nd  dorsal.  You  must  reason  according  to  the  centers  affected. 


SIGNIFICANCE   IN    SPINAL   EXAMINATION.  19 

If  there  is  a  change  from  the  natural  curve  in  the  region  of  the  splanch- 
nics  from  below  the  shoulders  to  the  first  lumbar,  then  look  for  such 
troubles  as  intestinal  affections,  renal  troubles.  This  same  reasoning 
applies  in  genera!  to  the  sacrum  and  coccyx.  The  coccyx  may  cause 
either  mechanical  troubles,  such  as  piles  and  constipation,  or  sympathetic 
trouble  and  affect  the  internal  viscera  in  that  way. 

The  Osteopath  finds  the  ATLAS  of  great  importance  to  him  in  his 
work,  for  the  reason  that  it  may  impinge  upon  certain  nerves,  and  may 
affect  spinal  centers;  or  it  may  act  in  such  a  way  as  to  deprive  the  brain 
of  its  supply  of  blood,  and  thus  lead  to  results  which  are  very  significant 
to  the  Osteopath.  It  may  act  in  such  a  way  as  to  shut  off  the  blood 
supply  to  the  brain,  and  it  may  affect  every  center  in  the  brain.  Hence, 
you  may  find  that  your  patient  has  been  unable  to  speak  for  a  long  time, 
or  has  been  unable  to  hear  plainly,  or  he  may  have  become  insane.  It 
may  also  impinge  so  much  that  it  presses  on  the  cord  and  robs  it  of  its 
nutrition,  so  that  there  may  follow  various  spinal  troubles.  It  may  press 
upon  it  on  one  side,  causing  hemiphlegia,  the  patient  having  no  use  of 
one  half  of  his  body,  the  legs  and  arms  being  small  in  the  case  of  a  child 
where  the  development  has  been  impaired.  This  is  the  Osteopathic  way 
of  looking  at  a  case  when  you  find  that  the  first  cervical  has  been  slipped. 
I  had  a  case  of  this  kind  not  long  ago.  The  result  of  a  slipped  atlas  was 
that  the  child  could  not  speak;  it  could  say  "Mamma,"  but  everything 
else  that  it  saul  was  just  a  peculiar  sound;  it  could  not  articulate  except 
that  single  word.  In  addition  to  that  its  left  side  was  paralyzed,  or  there 
was  a  paresis  there;  the  child  limped,  the  leg  was  short  and  the  arm  was 
drawn  up.  The  whole  trouble  was  really  at  the  first  cervical  vertebra, 
which  was  slipped,  affecting  the  spinal  cord  and  the  brain,  either  through 
its  blood  supply  or  directly  by  impingement. 

What  is  the  SIGNIFICANCE  OF  THE  NOISES  that  we  cause  along  the 
spine?  Sometimes  nothing  whatever.  You  may  find  noises  all  along 
the  spine  in  a  man  who  is  quite  healthy.  But  on  the  other  hand1,  it  may 
have  considerable  significance,  and  this  the  Osteopath  should  always  take 
into  consideration.  As  I  have  explained,  either  the  heads  or  tuberosities 
of  the  ribs  may  be  slipped,  or  the  position  of  the  vertebra  may  be 
changed,  or  the  articular  processes  may  cause  a  great  deal  of  trouble  in 
the  neck.  The  Osteopath,  in  thinking  of  these  things,  thinks  of  the  nor- 
mal anatomy  of  the  part.  He  says,  here  is  a  point  which  may  be  subjected 
to  a  strain  or  twist,  it  can  be  extended  or  shortened  to  some  extent,  so 
that  these  are  moveable  points;  and  being  points  at  which  a  strain  may 
occur,  are  points  which  are  liable  to  disease.  You  will  find  this  of  great 
significance  in  the  etiology  of,  spinal  curvature.  Along  this  line  I  will 
quote  from  Hilton.  He  says:  "Diseases  of  the  spine  may  begin  in  the 
vertebrae  or  in  the  inter-vertebral  substances;  I  think  on  the  whole,  in  the 


20  SIGNIFICANCE-  IN   SPINAL   EXAMINATION. 

inter-vertebral  substances  where  it  is  joined  to  the  vertebrae."  His  editor, 
Dr.  Jacobs,  says  that  his  view  is  supported  by  the  fact  that  the  junction 
of  a  more  with  a  less  elastic  body  is  the  weakest  spot  and  therefore 
receives  the  full  effect  of  the  strain.  He  instances  the  case  of  an 
atheromatous  artery,  the  weakest  portion  is  where  the  diseased  wall  joins 
with  the  more  elastic  substance  of  the  healthy  wall,  and  it  is  at  that  point 
that  the  real  strain  comes,  and  that  an  aneurism  is  likely  to  occur.  Hence, 
as  explained,  here  arises  for  the  Osteopath  the  significance  of  a  distorted 
vertebra,  causing  a  slight  irritation  of  the  parts,  throwing  too  much  blood 
and  nerve  force  and  life  there,  and  setting  up  some  irritation,  causing  a 
thickening  of  the  ligaments  and  perhaps  a  permanent  injury  to  certain 
parts,  especially  the  nerves. 

The  Osteopath  realizes  that  the  ILL  EFFECTS  OF   INJURIES  ALONG  THE 

SPINE  ARE   NOT  DEPENDENT  UPON   THEIR  GREAT  EXTENT.      That   is  to    Say,   yOU 

may  have  a  very  bad  curvature  of  the  spine  which  is  congenital,  or  there 
may  be  a  very  bad  curvature  of  the  spine  which  had  come  on  through 
years,  without  very  serious  organic  trouble  following.  In  such  cases 
where  the  curvature  has  covered  a  very  long  period  of  time,  or  where  a 
child  has  been  born  so,  the  parts  become  adapted  to  the  variation  from 
the  normal,  and  such  persons  may  go  through  life  with  good  organic  life. 
I  have  seen  some  cases  of  dwarfs  or  hunch-backs,  who  had  very  good 
health;  and  reasoning  from  the  Osteopathic  standpoint,  we  sometimes 
wonder  why  it  is  in  such  pronounced  curvatures  of  the  spine,  the  person 
does  not  have  stomach  trouble,  bowel  trouble,  why  the  kidneys  are  not 
affected,  and  so  on.  On  the  other  hand,  you  may  have  a  man  with  a  sound 
back,  but  who  has  a  little  twist  of  one  vertebra,  which  may  make  him  a 
great  deal  of  organic  trouble.  So  the  Osteopath  reasons  not  from  tht 
great  extent  of  the  departure  from  normal,  but  from  the  center  affected, 
and  from  antecedent  conditions.  Hilton  says  that  almost  all  diseases  of 
the  spine  are  the  result  of  some  slight  strain  or  some  slight  accident,  and 
that  is  what  the  Osteopath  finds  every  week  of  his  practice.  A  man  will 
come  into  your  office  in  trouble;  you  will  find  a  spinal  lesion.  He  knows 
he  never  fell,  a  horse  never  kicked  him,  or  anything  of  that  kind,  but 
later  he  will  come  and  tell  you  that  he  remembers  some  past  injury.  He 
has  had  some  accident  which  he  had  overlooked,  but  which  has  caused 
some  slight  lesion  of  the  spine,  taking  time  to  develop,  but  which  has  at 
last  caused  considerable  trouble.  Hilton  also  instances  a  very  serious 
case  in  which  the  lesion  of  the  spine  was  not  discovered  at  all;  it  was 
only  after  the  patient  had  been  fourteen  years  a  paralytic  and  died  that 
post  mortem  revealed  the  fact  that  the  5th,  6th  and  7th  cervical  vertebra; 
had  been  ankylosed.  The  fall  which  caused  it  was  a  fall  of  forty  feet  upon 
his  back  and  neck;  upon  examination  of  the  patient  he  was  unable  to  find 


SIGNIFICANT   POINTS    IN    DIAGNOSIS.  21 

any  lesion  in  these  parts  at  the  time.     So  the  lesion  may  not  be1  discov- 
erable. 

Once  more,  Hilton  says  that  he  believes  many  cases  of  spinal  diseases 
are  due  to  a  slight  injury  which  has  been  overlooked,  or  to  exercise 
persisted  in  after  fatigue.  A  man  falls  down,  says  he  has  not  been  hurt, 
gets  up  and  rubs  himself  to  restore  circulation,  and  thinks  nothing  more 
of  it;  but  as  Hilton  says,  very  slight  injury  may  cause  very  serious 
results,  and  the  Osteopath  has  to  take  all  these  things  into  consideration, 
and  reason  accordingly. 


LECTURE  V. 

At  the  last  lecture  I  called  your  attention  to  how  to  examine  the 
spine,  concluding  that  subject.  I  also  took  up  the  Osteopathic  signific- 
ance of  certain  special  points  which  we  had  before  noticed  in  our  examin- 
ation of  the  spine.  In  general,  a  lesion  affects  a  center  over  which  it 
occurs.  The  Osteopath  reasons  from  the  amount  or  intensity  of  nerve 
force  displayed  at  any  point.  Spines  may  be  separate  or  approximated. 
I  called  your  attention  to  the  special  vertebrae,  the  2nd  and  7th  cervical, 
and  lesion  at  the  2th  dorsal  and  5th  lumbar,  and  instanced  the  results  of 
such  lesions.  I  called  your  attention  to  the  displacement  of  the  atlas, 
stating  that  it  was  of  great  significance  to  the  Osteopath,  as  it  may  shut 
off  blood  supply  to  the  brain  and  may  impinge  upon  the  cord,  causing 
serious  troubles.  I  also  called  your  attention,  finally,  to  the  fact  that  the 
Osteopath  does_not  measure  the  injury  by  its  vast  extent,  instancing  the 
case  of  the  hunch-back  with  good  organic  health,  versus  the  case  of  a 
man  with  a  slight  slip  or  twist  of  one  vertebra  having  great  trouble. 

I  wish  to-day  to  continue  this  line  of  thought,  taking  up  then,  as  the 
head  of  this  lecture :  The  further  consideration  of  the  Osteopathic  signifi- 
cance of  points  in  diagnosis.  I  failed  to  explain  fully  to  you  the  signifi- 
cance of  the  CLICKING  IN  THE  NECK.  From  what  I  said  you  may  have 
gathered  the  impression  that  it  has  no  significance,  or  very  slight,  as 
those  noises  which  occur  lower  in  the  spine.  Such  is  not  the  case,  how- 
ever; if  you  hear  the  click,  the  reason  is  because  something  has  shut  off 
the  blood  supply,  it  may  have  been  a  little  strain,  a  congestion  of  the 
muscles,  anything  that  will  produce  a  tension  over  the  blood  vessels,  or 
affect  their  vaso-motor  fibres,  causing  a  contraction  and  shutting  off  the 
blood.  This  may  prevent  the  right  amount  of  lubrication  being  deposited 
in  the  synovial  membrane  between  the  articular  processes  of  the  vertebrae, 
hence  you  have  the  vertebrae  too  close  together,  and  the  patient  in  turn- 
ing his  head,  or  upon  its  being  turned  by  the  .operator,  elicits  a  click  or 


22  SIGNIFICANCE   OF   POINTS   IN    DIAGNOSIS. 

grating  sound,  and  the  patient  wonders  what  this  is.    To  you  such  noises 
are  of  considerable  significance. 

You  may  find  it  useful  to  consider  the  various  troubles  which'  you  will 
find  in  your  practice  IN  RELATION  TO  THE  PLEXUSES  from  which  they  arise, 
and  if  you  adapt  yourself  to  the  habit  of  thought,  and  at  once  think,  when 
you  see  trouble  in  one  part  of  the  body,  where  it  may  have  come  from, 
what  plexus  is  affected,  and  what  region  in  the  spine,  I  believe  it  will  be 
of  considerable  use  to  you.  Now,  there  may  be  LESIONS  OF  CERTAIN  GROUPS 
OF  NERVES, — the  UPPER  CERVICAL  GROUP  of  nerves,  those  from  the  first  to 
fourth  inclusive,  may  be  affected  by  spasms,  neuralgia,  or  by  paralysis, 
in  general.^  I  wish  to  call  your  attention  to  some  points  in  relation  to  the 
distribution  of  nerves,  and  show  you  how  important  it  will  be  to  you  as 
Osteopaths  to  have  a  knowledge  which  you  can  quickly  call  into  use,  of 
the  distribution  of  the  various  nerves  in  the  body.  You  may  have  a 
pain  in  the  ear — the  person  whom  it  affects  may  describe  it  as  ear-ache. 
If  this  ear-ache  occurs  upon  the  anterior  pendulous  portion  of  the  ear,  or 
upon  the  posterior  aspect  of  the  ear,  you  will  have  to  refer  that  pain  to 
the  2nd  cervical  nerve,  which  supplies  those  parts.  If  the  ear-ache  is  in 
the  canal  of  the  ear,  or  the  upper  anterior  portion  of  the  ear,  you  will 
have  to  refer  that  trouble  to  the  5th  cranial  nerve.  Hilton  states  how 
it  was  that  he  happened  to  find  so  definitely  just  how  these  nerves  were 
distributed  to  the  ear.  The  case  was  that  in  which  an  attempt  had  been 
made  to  cut  a  person's  throat;  the  auricular  branch  of  the  second  cervical 
nerve  had  been  divided  so  that  sensibility  had  entirely  departed  from  the 
posterior  and  lower  parts  of  the  ear.  By  pricking  very  carefully  over  the 
whole  surface  of  the  ear  he  fbund  just  the  distribution  of  the  nerves. 
You  may  have  the  ear-ache  and  tooth-ache.  And  why?  Simply  because 
the  5th  nerve  supplying  the  auditory  canal  supplies  also,  by  the  superior 
and  inferior  maxillary  branches,  the  teeth  of  the  upper  and  lower  jaws 
respectively.  You  may  have  ear-ache  associated  with  disease  of  the 
anterior  third  of  the  tongue,  because  the  5th  nerve,  which  supplies  sensa- 
tion to  the  anterior  third  of  the  tongue  also  supplies  the  auditory  canal. 
Pain  in  the  anterior  lateral  part  of  the  scalp,  over  the  temples,  pain  in  the 
face,  eyes,  nose,  tongue,  or  teeth,  you  refer  to  this  same  5th  cranial  nerve. 
On  the  other  hand,  in  case  the  pain  is  in  the  back  of  the  scalp,  we  have 
two  areas,  one  supplied  by  the  great  occipital  nerve,  and  one  by  the  small 
occipital  branch  of  the  2nd  cervical  nerve.  So  it  is  that  you  have  these 
areas  of  distribution  given  so  that  you  can  refer  pains  in  a  particular  part 
to  the  origin  of  the  nerves.  Both  the  5th  nerve  and  these  upper  cervical 
nerves  are  readily  accessible  to  the  operator.  You  thus  see  what  the 
significance  of  these  things  is  to  the  Osteopath  in  enabling  him  to  make 
a  correct  diagnosis.  If  he  is  not  acquainted  with  the  distribution  of  these 
nerves,  he  is  not  able  to  trace  back  and  find  the  seat  of  the  lesion.  So  it  is 


PRINCIPLES   OF   OSTEOPATHIC   DIAGNOSIS.  23 

by  following  correctly  the  distribution  of  the  nerves  yon  may  fit  yourself 
to  make  a  correct  diagnosis. 

In  general  the  diseases  which  occur  from  lesions  in  the  upper  cervical 
region  are  such  troubles  as  torticollis,  troubles  with  the  phrenic  nerve — 
hiccough,  neuralgia,  and  troubles  of  that  kind.  Of  course  the  Osteopath 
finds  trouble  with  the  phrenic  nerve  lower  than  the  upper  cervical  group, 
generally  arising  from  the  3rd,  4th  and  5th  cervical.  When  an  Osteopath 
meets  such  disease  as  crutch  paralysis,  or  writer's,  violinist's  or  pianist's 
cramp,  he  refers  such  cases  to  the  plexus  at  some  point,  or  to  a  lesion 
affecting  it  centrally.  T  remember  a  case  of  crutch  paralysis  which  I 
treated.  It  was  secondary  from  the  use  of  a  crutch,  the  crutch  pressing 
upon  the  median  nerve  which  comes  from  the  inner  and  outer  cords,  thus 
affecting  that  nerve  and  consequently  the  thumb  and  first  finger  which 
are  supplied  by  it.  Learn,  then,  to  reason  as  to  which  plexus  is  affected. 
Having  known  this  and'  how  to  treat  it,  your  diagnosis  will  be  correct, 
and  you  will  be  able  to  go  understandingly  about  what  you  are  trying  to 
reach. 

Hilton  considers  diseases  of  the  upper  cervical  vertebrae  among  the 
most  serious  which  may  affect  the  spine.  I  quote  from  him  as  follows: 
"No  cases  of  disease  of  the  spine  are  so  immediately  dangerous  to  life 
as  those  of  the  upper  part  of  the  cervical  region,  especially  if  situated 
between  the  first  and  second  cervical  vertebrae."  The  reason  of  this  is 
the  close  proximity  of  the  bones  to  the  spinal  cord.  There  is  danger  of 
rupture  of  the  ligaments  about  the  odontoid  process  of  the  axis,  and  in 
case  this  is  ruptured  or  worn  away  by  disease,  the  medulla  may  be 
impinged  upon,  thus  affecting  the  centers  located  there,  especially  the 
center  of  respiration,  and  so  cause  death.  He  instances  a  case  which  I 
have  thought  would  be  useful  to  you.  He  had  a  i"ase  of  a  lady  who  was 
affected  thus:  She  had  pains  upon  the  left  side  of  her  head  at  the  back, 
pains  behind  the  ear,  and  over  the  clavicle  and  shoulder,  pains  and 
muscular  paralysis  of  the  left  arm  and  deeper  pain  in  the  neck,  which 
became  apparent  by  pressure  of  the  head  down  upon  the  spine,  and  rota- 
tion. He  found  that  about  the  ist,  2nd  and  3rd  cervical  vertebrae  there 
was  some  tenderness  slightly  more  marked  on  the  left  than  on  the  right. 
He  anticipated,  that  there  was  a  history  of  some  accident,  but  could  find 
none,  as  the  lady  knew  of  no  accident  that  had  occured.  Her  general 
health  was  very  much  affected;  she  was  unable  to  work;  for  she  had  very 
sleepless  nights,  and  her  nervous  system  was  very  much  affected.  He 
diagnosed  this  case  from  the  tenderness  in  the  cervical  region;  he  diag- 
nosed it  as  a  disease  affecting  the  second  cervical  nerve,  hence  the  pain 
is  in  the  back  of  the  head;  as  affecting  the  3rd,  hence  its  distribution,  also 
as  affecting  those  parts  supplied  by  the  nerves  which  go  to  make  up  the 
brachial  plexus. 


24  PRINCIPLES   OF   OSTEOPATHIC   DIAGNOSIS. 

I  bring  this  out  to  demonstrate  the  need  of  accuracy  in  diagnosis,  the 
need  of  reasoning  closely  along  the  lines  of  distribution  of  nerves.  In  this 
case.  Hilton  found  that  the  urine  was  affected,  that  it  was  ammoniacal,  and 
a  less  skillful  physician  would  have  treated  the  case  for  bladder  trouble, 
as  indeed  often  occurs.  The  point  I  wish  to  make  is,  that  THE  OSTEOPATH 

MUST   NOT  BE  CARRIED   ASTRAY   BY   GENERAL    SYMPTOMS.       So    where   yOU   find 

foul  urine,  pain  in  the  bladder,  and  things  of  that  kind,  you  may  be  led 
astray;  you  surely  will  be  if  you  are  not  one  who  knows  his  business.  It 
is  the  dictum  of  one  of  the  old  schools,  to  ''watch  the  symp- 
toms carefully  and  treat  them  as  they  arise."  And  that  has 
seemed  to  be  the  practice  followed.  But  it  does  not  need  much  reasoning 
to  show  you  that  should  an  Osteopath  adopt  such  a  course,  he  would 
rapidly  become  a  failure  in  his  chosen  profession.  There  was  a  case  here 
some  time  ago — a  young  man  from  Springfield,  111.,  came  here  with  one 
leg  shorter  than  the  other.  He  used  crutches;  he  had  a  severe  pain  on 
one  side  of  the  knee  of  the  affected  limb.  That  man  had  traveled  exten- 
sively seeking  help.  He  had  been  massaged  and  treated  in  almost  every 
conceivable  way;  had  lived  in  the  hospitals  for  months.  But  one  day  he 
said  to  the  physician  in  charge,  "How  does  it  happen  that  that  leg  is 
shorter;  what  is  the  trouble  with  that  knee?"  "Well,"  he  said,  "the  bones 
may  be  separated  and  the  tibia  may  have  been  pushed  up,  thus  shortening 
that  limb."  If  I  remember  correctly,  that  case  was  cured  practically  in 
one  treatment.  I  do  not  say  this  to  illustrate  our  quick  cures.  The 
treatment  was  sufficient  because  the  muscles  had  been  massaged,  and 
were  softened  and  ready  to  be  worked  upon.  The  hip  was  set.  I  became 
acquainted  with  the  young  man  later.  I  realized  what  it  was  to  have  the 
deformity  cured.  He  had  been  treated  for  years  for  the  knee,  but  the 
trouble  was  in  the  hip.  This  is  almost  a  threadbare  illustration  of  what 
Osteopathy  does;  but  it  illustrates  my  point  perfectly.  If  you  follow  up 
the  symptoms  and  treat  them  as  they  arise,  you  will  land  in  obscurity.  1 
do  not  wish  to  criticise  any  system  of  medicine,  but  from  our  standpoint 
it  will  not  do  for  an  Osteopath  to  work  in  that  way.  If  he  does,  he  is  a 
poor  Osteopath  and  does  not  understand  what  he  is  trying  to  do,  and 
simply  makes  what  Doctor-  Still  calls  an  "engine  wiper."  He  goes  to 
the  seat  of  pain,  and  not  the  seat  of  the  trouble.  He  becomes  a  masseur, 
and,  in  his  case,  the  criticism  could  justly  be  made,  that  Osteopathy  is 
nothing  but  massage. 

This  same  point  was  brought  out  some  time  ago.  We  mentioned 
two  things  that  made  up  the  success  of  the  Osteopath.  The  first  was  in 
not  being  too  rough  in  our  treatment,  but  the  one  I  want  to  call  your 
attention  to  especially  was  that  Osteopathy  makes  correct  diagnoses.  It 
goes  back  to  the  original  cause,  and  does  not  depend  upon  symptoms 
"merely. 


PRINCIPLES   OF   OSTEOPATHIC   DIAGNOSIS.  25 

I  wish  to  call  your  attention  to  the  following  point :    THAT  PAIN  UPON 

THE  SURFACE  OF  THE  BODY,  NOT  ACCOMPANIED  BY  ANY  RISE  IN  TEMPERA- 
TURE, INDICATES  A  DISTANT  ORIGIN  OF  THE  TROUBLE,  AND  THAT  TROUBLE  IS 
USUALLY  IN  THE  SPINE. 

Hilton  says  that  if  this  pain  be  upon  the  cutaneous  surtace,  it  will 
indicate  spinal  disease  in  every  case.  I  have  had  a  drawing  put  here- 
showing  "a"  and  "b,"  the  distribution  respectively  of  the  6th  and  7th 
dorsal  nerves.  They  meet  over  the  pit  of  the  stomach  in  the  skin,  and 
will  refer  a  pain  to  that  point.  The  patient  thinks  the  trouble  is  there; 
his  trouble  is  invariably  at  the  spine.  He,  of  course,  will  want  you  to 
treat  the  affected1  spot.  There  is  a  case  on  record  of  pain  in  the  pubes 
and  over  the  lower  part  of  the  abdomen.  The  physician  finding  the 
trouble  in  the  lower  part  of  the  spine,  it  being  associated  with  paralysis 
of  the  lower  limbs,  decided  it  was  spinal  trouble  and  rubbed  an  oint- 
ment on  the  spine.  The  patient  thinking  the  symptoms  should  be  treated, 
rubbed  the  ointment  over  the  lower  part  of  the  abdomen,  being  paid  for 
his  interference  by  a  great  deal  of  smarting.  He  wanted  to  treat  the 
seat  of  the  pain  instead  the  seat  of  the  lesion.  It  is  true  that  these  pains 
are  not  mere  happen  so's.  They  depend  upon  a  close  connection,  as  in 
this  case,  of  the  nerves.  His  close  connection  may  be  either  through 
the  spinal  nerves  or  it  may  be  through  the  sympathetic  system.  You 
may  have  a  pain  at  a  part,  which  you  may  trace  up  through  a  nerve, 
back  through  the  cord  to  the  brain  or  center,  down  another  nerve  to 
the  original  cause;  so  that  an  original  cause  may  act  along  a  nerve, 
through  a  center,  and  out  through  another  nerve.  THE  SEAT  OF  THE  PAIN 
is  NOT  ALWAYS  THE  SEAT  OF  THE  LESION.  If  such  a  patient  comes  to  you, 
do  not  become  a  masseur;  do  not  treat  the  seat  of  his  pain,  but  treat 
the  seat  of  the  lesion  causing  the  trouble,  and  convert  him  by  showing 
him  true  Osteopathy. 

A  PECULIAR  PHENOMENON  is  often  witnessed.  You  may  meet  a  case 
in  which  one  part  of  the  body  is  more  sensitive  than  another;  you  may 
have  paralysis,  both  muscular  and  sensory,  below  an  injured  part,  with 
acute  hyper-aesthesia  above.  The  explanation  which  has  been  given  in 
such  a  case  is  two-fold.  In  the  first  place,  take  such  a  case  as  a  fracture 
of  the  spine;  the  parts  about  the  site  of  the  injury  are  the  seat  of  the 
inflammation;  after  the  fracture  the  parts  are  engorged  with  blood; 
there  are  exudations,  both  fluid  and  cellular,  about  the  parts,  which  may 
press  upon  the  origins  of  the  nerves  just  above  the  seat  of  the  fracture, 
and  may  irritate  for  a  considerable  distance  up  the  spine,  thus  causing 
considerable  sensation  above.  Below,  the  nerves  have  been  injured  by 
the  trauma  to  the  cord  causing  paralysis.  The  other  explana- 
tion is  the  same  except  that  in  it  the  origin  of  the  spinal 
nerves  is  taken  into  consideration;  as  you  go  further  down  the 


26  PRINCIPLES   OF   OSTEOPATHIC    DIAGNOSIS. 

spinal  column  you  will  find  that  the  roots  run  more  and 
more  obliquely  in  the  canal,  until  finally  the  lower  ones  run  an  inch 
and  a  half  or  an  inch  and  three-quarters  before  emerging.  When  the 
impingement  is  upon  the  origin  of  those  nerves,  the  pain  will  be  at 
their  distribution  upon  the  muscle  and  surface  of  the  body.  I  had  a  case 
similar  to  this,  a  man  who  is  still  in  town  for  treatment.  He  has  paralysis 
of  the  lower  limbs,  almost  a  complete  lack  of  muscular  ability  and  of 
sensibility  in  the  lower  limbs.  The  lesion'  is  in  the  lower  part  of  the 
spine.  He  has  a  terrible  itching  and  smarting  along  the  spine;  upon 
treatment,  however,  he  readily  recovers  from  these  symptoms.  Now, 
the  explanation  may  be  similar  to  that  given,  -and  it  may  partake  of 
the  reasoning  that  I  gave  you  the  other  day  concerning  Osteopathic 
matters.  That  is,  that  there  is  too  much  life  above,  and  there  is  too 
little  life  below;  something  has  interfered  to  cut  off  nerve  and  blood 
flow  below,  while  that  above  is  supplied  with  its  full  quota  already  and 
does  not  need  that  which  is  misdirected  to  it,  thus  there  is  irritation  to 
the  parts  above  and  the  resulting  symptoms.  What,  the  Osteopath  does 
is,  as  was  indicated,  to  try  to  restore  the  equilibrium  of  nerve  and  blood 
forces  to  the  lower  parts  of  the  body  which  are  suffering,  and  then  to 
the  parts  which  are  impinged  upon  above.  To  do  this  he  goes  back  to 
the  parts  affected. 

Q.  In  the  event  of  peripheral  trouble,  sensation,  would  you  also  find 
the  sensation  at  the  origin? 

A.  Not  necessarily.  You  might  not  have  any  sensation  there, 
Otherwise,  the  patient  would  have  himself  perhaps  discovered  it.  You 
may  not  have  a  sore  spot  at  all;  .it  may  be  such  a  lesion  as  spreading  of 
the  spines  or  approximation  of  the  spines,  not  necessarily  any  tender- 
ness at  the  central  point,  at  the  lesion. 

Q.  Are  there  no  exceptions  to  the  rule  that  where  there  is  pain  on 
the  surface,  not  accompanied  with  rise  of  temperature,  the  trouble  is  of 
spinal  origin? 

A.  I  took  Hilton  as  authority  there,  and  he  gives  this  example 
It  is  just  as  invariable  as  in  the  case  of  inflammation,  in  which  the  prin- 
cipal sign  is  rise  of  temperature.  You  may  have  the  swelling  and  the 
pain  without  inflammation,  but  if  you  have  these  two,  ami  heat  also,  it 
is  a  sign  of  inflammation.  He  makes  a  parallel  and  says  it  is  just  as  in- 
variable that  if  there  is  pain  upon  the  surface  of  the  body,  not  accom- 
panied by  rise  in  temperature,  the  cause  is  of  spinal  origin;  he  does  not 
make  any  exception. 

Q.  I  understood  yon  to  say  that  the  5th  nerve  was  reached  through 
the  sympathetic? 

A.  The  5th  cranial  is  reached  through  the  superior  cervical  gang- 
lion. We  get  results  which  justify  us  in  saying  this;  any  operator  will 


PRINCIPLES   OP   OSTEOPATHIC   DIAGNOSIS.  27 

tell  you  that  he  gets  results  from  the  superior  cervical  that  influence  the 
5th  nerve.  Of  course  he  does  it  by  sympathetic  connection,  which  I  will 
explain  at  another  time. 

Q.  In  the  case  of  that  man  with  the  pain  on  the  inside  of  the  knee, 
suppose  that  he  should  have  had  localized  trouble  at  the  knee,  would 
you  have  recognized  the  condition  by  the  lesion  in  the  spine? 

A.  Yes,  partly,  and  you  would  have  to  go  into  the  history  of  the 
case.  You  would  have  to  go  back  to  your  centers  and  determine  what 
was  the  trouble. 

The  first  thing  would  be  to  go  to  the  spine  and  thoroughly  examine; 
if  you  find  a  lesion  there,  the  probabilities  are  it  is  of  spinal  origin.  You 
should  by  all  means,  whenever  you  have  such  a  case,  or  any  case,  go 
back  to  the  center  of  the  nerve  supply,  and  you  may  find  a  lesion  there, 
above  or  below  the  center,  or  you  may  not  have  a  distinguishable  lesion. 

Q.  In  the  event  of  a  severe  gastritis  would  there  be  a  soreness  in 
the  spinal  region? 

A.  Very  likely  there  would  be,  and  in  that  case  your  soreness  and 
congestion  of  the  muscles  would  be  what  I  have  explained  as  secondary. 

Q.     Which  would  be  secondary? 

A.  The  congestion  of  the  muscles  along  the  spine.  In  a  case  of 
severe  gastritis  you  would  very  likely  find  sore  spots  along  the  spine. 
The  explanation  being  that  the  nerve  influence  from  the  disturbed 
stomach  travels  along  the  sympathetic  branches  of  the  solar  plexus  back 
to  the  spinal  connection  of  those  nerves,  and  then  passes  through  to  the 
peripheral  termination  of  the  spinal  nerves  in  the  muscles  of  the  back. 

Q.  Is  it  true  that  you  can  designate  which  organ  of  the  body  is  in 
trouble  by  finding  the  tenderness  in  certain  spots  in  the  spine? 

A.  Yes,  in  ..general  that  is  true.  I  thought  I  brought  that  point  out 
in  my  last  lecture.  The  sore  spots  may  be  due  to  either  peripheral  or 
central  trouble,  and  by  determining  whether  they  are  primary  or  sec- 
ondary you  may  locate  the  trouble  by  reasoning  from  the  center  to  the 
periphery. 


LECTURE   VI. 

At  the  last  lecture  I  called  your  attention  to  the  further  significance 
of  the  clicking  in  the  neck,  stating  that  it  frequently  meant  a  lack  of 
lubrication  secreted  in  the  synovial  membranes.  I  began  to  take  up  the 
general  effects  of  lesions  of  plexuses  along  the  spine,  taking  up  the  first 
group,  the  upper  four  cervical  nerves.  I  called  your  attention  to  the  fact 
that  pain  must  be  referred  to  the  origin  of  the  nerve  supplying  a  part, 
instancing  the  anterior  pendulous  portion  of  the  ear  and  the  posterior 


28  PRINCIPLES   OF   OSTEOPATHIC   DIAGNOSIS. 

portion  of  the  ear  as  being  supplied  by  the  second  cervical  nerve,  versus 
pain  in  the  other  parts  of  the  ear  indicating  lesion  in  the  fifth  cranial 
nerve.  Hilton  considers  diseases  of  the  upper  cervical  portion  of  the 
spine  among  those  most  dangerous  to  life.  The  operator  must  not 
confuse  symptoms  with  causes.  He  must  not  take,  for  instance,  some 
symptom  which  may  be  prominent,  thinking  it  to  be  one  of  the  first 
causes.  If  there  is  pain  upon  the  surface  of  the  body  not  accompanied 
by  rise  in  temperature,  it  indicates  disease  of  spinal  origin.  A  peculiar 
phenomenon  often  witnessed  is  that  there  is  paralysis  of  sensation,  or 
motion,  or  both,  at  a  point  below  a  spinal  injury,  while  there  is  acute 
hyperesthesia  just  above.  The  explanation  was  given  that  it  was  owing 
in  part  to  the  obliquity  of  the  course  of  the  spinal  nerves,  in  part  to  the 
engorgement  of  the  parts  and  the  exudations,  fluid  and  cellular,  which 
take  place  around  a  serious  lesion  of  the  spinal  cord.  To-day  I  wish 
to  pursue  this  line  of  thought  somewhat  further,  hoping  to  finish  in  this 
lecture.  That  is,  this  general  point  of  the  significance  of  general  symp- 
toms to  the  Osteopath. 


I.     FURTHER  CONSIDERATION  OF  OSTEOPATHIC  SIGNIFI- 
CANCE OF  POINTS  FOUND  IN  DIAGNOSIS. 

The  lower  four  cervical  nerves  and  brachial  plexus  constitute  what  is 
known  as  the  SECOND  GROUP  OF  NERVES.  The  brachial  plexus  sends  short 
branches  to  the  shoulder  and  upper  intercostal  muscles,  and  long  branches 
to  the  arms.  In  general  the  effects  which  may  follow  lesions  to  the 
second  group  of  nerves  are  paralysis,  spasms  and  neuralgias.  Such 
troubles  the  operator  must  learn  to  refer  to  the  center ;  that  is,  to  the  origin 
of  the  plexus  along  the  spine.  Should  you  have  palsy  of  the  hand,  or 
oedema  which  is  neurotic  in  origin,  such  cases  you  must  refer  to  trouble  in 
the  brachial  plexus.  Of  course  this  is  speaking  of  these  nerves  as  mem- 
bers of  the  cerebro-spinal  system.  Please  remember,  also,  that  the  FIRST 

GROUP  OF   NERVES   IS   CONNECTED  WITH   THE  UPPER   CERVICAL  GANGLION  OF  THE 

SYMPATHETIC,  and   that  the  SECOND  GROUP  OF  NERVES  is  CONNECTED  WITH 

THE   SECOND  AND  THIRD  GANGLIA  OF   THE   SYMPATHETIC,   and   that   in  Case  the 

lesion  be  severe  enough  to  affect  sympathetic  life,  you  may,  in  lesions 
in  this  region,  have  far-reaching  disturbances.  Remember  also  that 
from  the  third,  fourth  and  fifth  cervical  nerves  arises  the  phrenic  nerve, 
and  that  injury  here  may  cause  diaphragmatic  trouble;  hiccoughs  for 
instance,  which  we  treat  in  that  region. 

The  THIRD  GROUP  OF  NERVES  is  composed  of  the  twelve  dorsal  nerves. 
Of  these  the  first  six  are  connected  ivith  the  first  six  dorsal  ganglia  of  the 
sympathetic,  and  the  last  six  but  one  are  connected  with  the  fifth  to  the 
twelfth  dorsal  ganglia  of  the  sympathetic.  In  their  capacity  as  spinal 


POINTS   IN   OSTEOPATHIC    DIAGNOSIS.  29 

nerves,  the  members  of  this  third  group  are  subject,  usually,  to  merely 
sensory  affections.  You  will  frequently  meet  in  your  practice,  cases  of 
intercostal  neuralgia.  This  the  Osteopath  diagnoses,  and  he  is  usually 
correct,  as  a  pressure  upon  the  nerves,  caused  by  crowding  together  of 
the  ribs.  Later,  when  we  come  to  the  consideration  of  the  thorax,  you 
will  find  that  we  make  prominent  the  point  that  the  ribs  are  dropped  to- 
gether frequently,  or  are  drawn  together,  and  you  will  learn  to  reason 
thus,  as  in  the  case  of  intercostal  neuralgia,  from  the  Osteopathic  point 
of  view.  Lesions  here  may  also  cause  herpes  zoster,  commonly  called 
shingles,  a  nervous  affection,  accompanied  by  eruptions  upon  the  skin. 
From  their  sympathetic  connections  this  group  of  nerves  may  be  asso- 
ciated with  troubles  of  the  pleura  or  lungs,  and  with  sympathetic  troubles 
of  the  viscera,  as  the  splanchnic  nerves  run  from  the  sympathetic  connec- 
tions of  the  dorsal  nerves  to  the  various  viscera, of  the  abdomen. 

The  FOURTH  GROUP  OF  NERVES  is  composed  of  the  five  lumbar  nerves, 
flic  upper  four  of  these  nerves,  ^vith  the  twelfth  dorsal,  arc  connected  with 
\]\e  upper  four  lumbar  ganglia  of  the  sympathetic.  Diseases  which  may 
affect  these  nerves  as  members  of  the  cerebro-spinal  system  are  mainly 
neuralgic.  Of  course  you  may  have  paralysis  or  spasms,  but  you  are 
not  so  liable  to  have  them  as  in  lesions  of  the  nerves  of  the  cervical  or 
sacral  region.  Sympathetic  troubles  would  occur  according  to  the  cen- 
ters with  which  these  nerves  are  connected. 

The  FIFTH  GROUP,  finally,  is  that  composed  of  the  five  sacral  nerves. 
These  five  sacral  nerves,  ^vith  the  fifth  lumbar,  arc  connected  with  the  five 
sacral  ganglia  of  the  sympathetic.  Lesions  affecting  these  spinal  nerves  are 
such  as  affect  the  cervical  nerves,  paralysis,  spasms,  and  neuralgias, 
which  may  vary  greatly  in  character.  You  may  have  tonic  or  clonic 
spasms  of  the  lower  limbs;  you  may  have  neuralgia,  such  as  sciatica;  or 
you  may  have  paralysis  of  the 'lower  limbs.  Sympathetically  you  would 
refer  to  such  troubles  as  are  indicated  in  the  outline  of  centers  given. 

I  have  thus  taken  up  the  grouping  of  the  nerves  along  the  spine.  Of 
course  it  has  been  very  general.  The  purpose  has  been  to  give  you  a 
general  view  of  regions  affected,  and  to  give  you  a  general  idea  of  how 
the  Osteopath  looks  at  disease;  that  is,  he  reasons  from  periphery  back 
to  center.  My  treatment  of  the  subject  has  necessarily  been  general, 
leaving  aside  a  more  particular  view  until  such  time  as  we  shall  take 
up  these  different  affections  which  we  meet,  more  in  detail.  I  may  in 
these  last  few  lectures  have  been  a  trifle  obscure;  I  find  it  a  rather  difficult 
subject  to  elaborate  and,  being  so  general,  it  may  have  been  indefinite. 
Still  I  trust  that  it  may  have  fulfilled  its  object,  which  was  briefly  as 
follows :  In  the  first  place,  to  indicate  to  you  the  necessity  of  keeping 
separate  in  your  mind  the  cerebro-spinal  system  and  the  sympathetic 
system.  Remember  that  you  cannot  separate  these  entirely,  but  look 


30  POINTS   IN   OSTEOPATHIC   DIAGNOSIS. 

for  symptoms  from  the  one  and  from  the  other.  You  do  not  really  find 
them  so  separated  in  your  practice.  Second,  to  impress  you  with  the  im- 
portance of  diagnosis  based  according  to  centers  affected.  Third,  to  teach 
you  not  to  confound  incidentals  with  essentials;  not  to  confuse  mere 
symptoms  with  causes  of  disease.  I  thought  I  could  thus  indicate  to 
you  that  Osteopathic  point  of  view,  that  Osteopathic  habit  of  mind  in 
looking  at  disease. 

Hilton  states  that  as  a  rule  PAIN  IN  DISEASE  OF  THE  LOWER  CERVICAL, 

DORSAL   AND   LUMBAR   REGIONS   IS  INDICATED  BY   PAINS   SYMMETRICALLY   UPON 

THE  SURFACE  OF  THE  BODY  ;  that  in  the  upper  cervical  region  being  not  indi- 
cated symmetrically  by  pain  upon  the  surface  of  the  body.  The  original 
cause  for  such  pains  we  would  look  for  in  a  central  lesion.  If  the 
trouble  be  bi-lateral,  located  on  each  side  of  the  'body,  we  would  look 
for  a  central  cause,  or  perhaps  the  cause  may  be  bi-lateral.  I  instanced 
a  case  at  the  last  lecture  of  pain  over  the  skin  at  the  pit  of  the  stomach, 
being  referred  to  the  course  of  the  nerves  to.  the  sixth  and  seventh  dorsal 
vertebrae.  Hilton  instances  a  case  in  which  a  boy  had  severe  pain  there; 
he  went  about  stooping,  holding  his  hands  over  that  region.  Upon  lying 
down  the~pain  disappeared  to  some  extent.  His  diagnosis  of  that  case 
was  that  there  was  trouble  at  the  sixth  and  seventh  vertebrae,  and  he 
found  disease  there  of  such  nature  that  it  exerted  pressure  upon  the 
sixth  and  seventh  nerves  upon  both  sides.  Another  case  similar  was 
more  complicated  in  that  it  led  to  vomiting.  Almost  any  physician  would 
have  diagnosed'  such  a  case  as  stomach  trouble,  no  doubt.  Hilton,  how- 
ever, upon  examining  the  tongue  found  no  indications  of  stomach 
trouble,  and  diagnosed  that  case  also  as  disease  of  the  sixth  and  seventh 
vertebrae,  directed  treatment  to  those  points,  and  was  successful  in  cur- 
ing the  case.  Sometimes  in  such  diseases  we  find  a  pinching  feeling 
about  the  body,  a  feeling  as  if  the  body  jvere  girdled.  Now,  as  to  the 
reasons  why  the  pains  are  symmetrical  in  these  parts  of  the  body,  I  have 
already  indicated.  But  why  they  do  not  occur  so  above  is  this:  the  dif- 
ference in  the  nature  of  the  vertebrae.  Thus,  below  the  second  cervical, 
the  vertebrae  articulate  with  each  other  by  their  bodies  and  articular  pro- 
cesses, but  above  that  point  it  is  different;  the  atlas  articulating  with 
the  occiput  by  just  two  points,  and  one  might  be  affected  without  com- 
municating with  the  other.  The  articulation  of  the  atlas  with  the  axis 
is  by  just  three  points;  the  odontoid  process  articulates  with  the  anterior 
arch  of  the  atlas,  and  the  bodies  by  the  articular  surfaces.  Now,  any  one 
of  them  may  be  affected,  and  it  is  the  rule  that  one  of  these  is  affected 
without  communicating  the  disease  to  the  other.  Thus  you  may  have 
a  symmetrical  distribution  of  the  pain  below  the  second  cervical,  but 
not  above. 


POINTS   IN    OSTKOPATHIC   DIAGNOSIS.  31 

*A  further  [joint  of  importance  is  that  if  a  certain  organ  is  affected, 
the  impulse  may  be  transmitted  sympathetically  from  it  and  be  reflected  to 
another  organ,  and  that  always  in  such  a  case  it  is  carried  to  that  organ 
connected  most  closely  by  nerve  strands  to  the  organ  first  affected.  Bryon 
Robinson  says  that  ganglia  of  the  sympathetic,  especially  the  cervical 
ganglia  and  the  abdominal  brain,  are  POINTS  OF  REORGANIZATION  OF  IM- 
PULSES sent  to  them,  and  of  REDISTRIBUTION  OF  THESE  REORGANIZED  IM- 
PULSES, which  are  sent  to  various  viscera,  in  general,  to  those  most  closely 
connected,  those  which  are  furnished  with  the  greatest  number  of  nerve 
filaments.  I  quote  him  as  follows:  "It  is  a  principal  in  physiology 
that  when  a  peripheral  irritation  is  sent  to  the  abdominal  brain,  the  re- 
organized forces  will  be  emitted  along  the  lines  of  least  resistance,  so 
that  the  organ  which  is  supplied  with  the  greatest  number  of  nerve 
strands  will  suffer  the  most."  He  cites  here  a  prominent  instance  of 
uterine  tumor  affecting  the  heart,  and  in  this  way,  that  the  influence  of 
the  uterine  tumor  upon  the  hypogastric  plexus  was  reflected  to  the 
solar  plexus,  where  it  was  reorganized  and  sent  out  along  the  spalchnics 
to  the  superior  cervical  ganglion  and  the  next  two  below  it,  and  was 
then  sent  out  along  the  three  cardiac  branches  to  the  heart,  thus  caus- 
ing an  irregularity  of  the  heart,  leading  finally  to  heart  disease.  This 
point  is  of  great  importance  to  the  Osteopath.  You  will  find  it  very  com- 
mon in  your  practice  to  find  a  case  of  uterine  trouble  resulting  in  head- 
ache. Thoroughly  apply  any  of  the  ordinary  methods  of  treatment 
to  the  headache,  and  they  will  be  unsuccessful.  You  must  learn  to 
diagnose  with  these  things  in  mind,  and  to  reason  according  to  the 
connection  of  these  parts  through  the  sympathetic  system.  Now,  in  the 
instance  given,  the  impulse  might  have  been  sent  differently.  It  might 
have  passed  from  the  hypogastric  plexus  to  the  solar  plexus,  being  there 
reorganized  and  then  sent  out  to  other  viscera  throughout  the  body,  as 
is  frequently  the  case.  Or  it  might  have  run  up  through  the  sym- 
pathetic cord,  reaching  the  medulla,  then  affecting  the  vagi  nerves,  re- 
sulting in  stomach  trouble.  Another  illustration  I  take  from  him.  He 
calls  to  mind  the  fact  that  the  kidneys,  ovaries,  uterus  and  fallopian 
tubes  of  the  female  are  developed  from  the  Wolffian  bodies  in  the  em- 
bryo. They  are  thus  closely  connected  in  nerve  and  'blood  supply,  and 
it  is  a  fact  that  uterine  trouble  results  often  in  kidney  trouble,  and  kid- 
ney trouble  may  very  readily  result  in  uterine  trouble.  In  such  a  case 
it  is  difficult  to  diagnose  the  case  according  to  the  symptoms,  and  to 
determine  what  must  be  the  original  cause.  These  secondary  symptoms 
are  frequently  quite  prominent,  and  treatment  directed  to  them  will  not 
necessarily  have  any  effect  upon  the  original  trouble. 


*See  appendix  2. 


32  LANDMARKS   OF  THE   SCAPULA. 

II.  LANDMARKS    CONCERNING   THE   SCAPULA.     Hclden 
instances    the   following   points   concerning   the   scapula.      First,   that   it 
covers  the  ribs  from  the  second  to  the  seventh  inclusive  on  either  side; 
that  its  superior  angle  is  beneath  the  trapezius  muscle;  that  its  inferior 
angle  is  beneath  the  latissimus  dorsi  muscle;  this  latissimus  dorsi  binds 
the  posterior  edge  of  the  scapula  closely  down  against  the  posterior  chest- 
wall  in  a  strong  person.     In  case  of  consumptives  the  scapula  is  allowed 
to  project  outward  at  its  lower  angles,  and  this  gives  the  peculiar  appear- 
ance which  is  called,  "scapulae  alatae."     A  horizontal  line  from  the  sixth 
dorsal   spine  to  the   inferior  angle  of  the  scapula  outlines  the  superior 
margin  of  the  latissimus  dorsi  muscle.     A  line  drawn  from  the  root  of 
the  spine  of  the  scapula  to  the  twelfth  dorsal  spine  outlines  the  inferior 
border  of  the  trapezius  muscle.     In  examining  a  back  it  is  convenient  to 
have  the  patient  sit  leaning  forward  with  the  hands  hanging  between  the 
thighs;  this  brings  the  spine  of  the  scapula  down  about  the  third  inter- 
costal space,  on  a  level  with  the   fissure  between  the  upper  and  lower 
lobes  of  the  lung. 

III.  HOW  TO  TREAT  A   SPINE :— Having  learned  how  to  ex- 
amine a  spine,  having  learned  also  the  significance  of  points  one  finds  along 
the  spine  in  his  examination,  the  next  question  naturally  is,  how  to  treat 
these  points  when  observed.      Often  these  noises  which  we  may  find  in 
treating  along  the  spine  are  of  peculiar  significance  in  this  way:     That 
often  ribs  pushed  back  into  place  cause  such  a  noise.    In  our  treatment  of 
a  spine  there  are  two  points  which  we  may  take  into  consideration;  two 
objects  which  we  may  have  in  view.     In  the  first  place,  we  may  wish  to 
TREAT  THE  SPINE  ITSELF.     In  the  second  place,  we  may  wish'  to  REACH,  BY 

TREATING    THE    CENTERS    ALONG    THE    SPINE,    THE    VISCERA    TO    WHICH    THESE 

NERVES  RUN.  It  is  not  always  possible  to  disassociate  these  in  your  prac- 
tice. I  have  divided  these  points  thus  simply  for  convenience  in  the 
consideration  of  them.  You  will,  in  practice,  not  be  able  to  separate  the 
results  upon  the  spine  itself  from  the  result  which  you  will  get  upon  the 
centers  when  working  along  the  spine,  but  the  Osteopathy  of  it  is  the 
same,  and  I  trust  will  be  made  clear  to  you  by  this  division. 

Now,  when  you  are  treating  a  patient,  one  very  good  way  to  treat  the 
spine,  to  get  everything  relaxed,  is  to  lay  the  patient  on  his  face.  The 
patient  usually  thinks  he  is  relaxed  when  he  may  not  be.  I  think  those 
of  you  who  are  familiar  with  Delsarte  methods  will  agree  with  me.  Your 
first  care  is  to  see  that  the  patient  has  become  fully  relaxed.  Now,  we 
wish  to  learn  how  it  is  that  we  may  affect  the  central  distribution  of  the 
sympathetic  nerve.  I  spoke  to  you  the  other  day  of  the  gray  rami  com- 
municantes  extending  from  the  ganglia  of  the  sympathetic  back  to  the 
spinal  column,  supplying  the  blood  vessels  of  the  dura  mater  and  of  the 
vertebrae,  and  the  ligaments.  Thus,  if  you  wish  to  treat  the  spine  itself, 


HOW   TO   TREAT   A    SPINE.  33 

wish  to  strengthen  it,  you  must  necessarily  direct  your  treatment  to 
reaching  these  vaso-motor  nerves  in  order  to  relax  and  allow  sufficient 
nutriment  to  be  sent  to  these  parts.  In  order  to  do  this  you  must  always 
first  relax  all  the  contractions  of  the  muscles  along  the  spine.  Very 
frequently  you  will  find  that  the  muscles  arc  contracted  unevenly  and 
slip  under  your  fingers.  That  is  a  test;  a  muscle  may  he  hard,  as  it 
naturally  isv  from  exercise;  then  the  hardness  is  homogenous.  The  first 
point,  then,  is  to  loosen  the  muscles,  and  in  doing  this  it  is  well  to 
bear  in  mind  that  you  must  work  against  the  course  of  the  muscle  fibres, 
the  deeper  ones  especially.  It  is  perhaps  easier  in  that  way  to  get  a 
relaxed  effect,  and  your  idea  should  be  to  work  in  such  a  way  as  not  to 
hurt  the  patient.  You  may  treat  so  hard  and  so  roughly  as  to  do  dam-- 
age. The  thing  you  should  guard  against  is  too  rough  treatment  as  you 
may  injure  delicate  parts.  In  seeking  to  relax  a  nerve  you  may  irritate 
it,  and  thus  cause  the  muscle  to  shrink.  You  should  not  manipulate  with 
the  tips  of  the  fingers,  you  should  turn  the  fingers  so  that  the  cushion  of 
the  finger  does  the  work,  and  in  that  way  thoroughly  relax  all  the  con- 
gested or  contracted  muscles  along  the  spine. 

What  if  you  do  not  have  any  contracted  muscles  there?  That,  of 
course,  is  the  condition  in  many  cases.  It  is  our  work  in  such  a  case, 
where  the  muscles  are  flabby  and  there  is  a  lack  of  tone,  to  stimulate  all 
along  the  spine  and  thus  to  tone  the  parts.  Do  not  be  afraid  of  being 
thorough  in  this  matter.  You  must  relax  all  the  muscles  from  the  occiput 
to  the  coccyx,  as  they  may  any  of  them  produce  sympathetic  troubles 
which  may  be  reflected  over«  a  considerable  portion  of  the  body. 

There  is  a  certain  amount  of  hair  splitting  done  over  the  terms  of 
desensitization  and  stimulation.  Their  significance  I  will  take  up  later, 
but  always  bear  in  mind  that  your  first  point  must  be  to  relax  contracted 
muscles  if  you  find  them;  if  you  do  not  find  them  your  work  should  be 
directed  toward  reaching  the  deeper  structures  mechanically  and  securing 
an  equal  distribution  of  nerve  force.  If  there  are  contractions,  no  matter 
what  your  final  treatment  is  to  be,  you  must  get  rid  of  those  contractions 
first.  While  the  patient  is  upon  his  face  there  is  an  important  effect 
which  we  get  upon  the  spine  itself.  The  WORK  ALONG  THE  SPINE  HAS  ITS 

EFFECT  UPON  THE  BODY  ACCORDING  TO  THE  CENTERS  REACHED.      Suppose  I  wish 

to  reach  the  center  going  to  supply  the  nutrition  for  these  parts,  I  spring 
the  spine,  using  the  arm  as  a  lever,  and  by  so  doing  you  can  exert  a  great 
deal  of  force.  Drawing  up  the  arms  raises  the  ribs,  and  at  the  same  time, 
by  springing  the  spine  I  can  get  a  considerable  force  all  along.  This  is 
one  way.  Another  way  is  to  draw  the  limbs  up;  you  will  find  this  a  very 
convenient  method,  this  of  course  will  bow  the  back  and  make  prominent 
the  spines,  then  you  can  readily  reach  under,  and  in  that  way  you  can 
spring  the  spine  or  any  part  of  it;  and  it  is  always  advisable  for  you  to 


34  HOW   TO   TREAT   A   SPINE. 

stretch  the  spine  in  that  way  rather  than  to  attempt  to  stretch  the  patient 
by  pulling  the  neck.  That  is  a  tensile  strain  upon  the  spinal  column,  and 
it  resists  more  than  it  does  a  lateral  force.  You  will  find  this  useful  in 
your  practice.  There  is  another  method  which  we  frequently  use;  placing 
one  elbow  down  against  the  upper  edge  of  the  pelvis,  and  the  othev 
against  the  promment  part  of  the  shoulder,  and  separating  them,  also 
reaching  over  the  spines  of  the  vertebrae,  you  relax  all  along  the  spine. 
When  you  have  done  this  upon  one  side,  repeat  it  on  the  other.  And 
why?  Because  when  you  spring  the  spine  in  this  way  all  along  you  have 
stretched  the  ligaments  upon  that  side,  but  you  have  not  stretched  the 
others.  You  can  readily  see  that  as  I  spring  these  spines  the  effect  must 
be  to  stretch  the  ligaments  on  the  convex  side,  and  to  relax  the  ligaments 
on  the  concave  side  of  the  curve.  So  you  must  turn  the  patient  over, 
treat  the  other  side,  providing  you  wish  to  treat  the  ligaments  upon  both 
sides  of  the  spine.  You  may  treat  the  muscles  alone  in  this  way.  When 
you  have  that  object  in  view,  usually  you  must  exert  considerable  force,  but 
do  not  dig.  Do  not  use  the  ends  of  your  fingers.  You  can  develop 
strength  so  that  you  can  keep  the  fingers  flat  and  work  with  the  cushion 
of  the  fingers  against  the  muscle,  and  in  this  way  you  can  get  a  good 
effect  upon  the  muscles  themselves.  Do  not  be  afraid,  but  keep  at  it 
until  they  are  relaxed;  do  not  treat  too  hard  or  you  may  stimulate,  and 
they  will  contract  more,  but  by  deep  work  along  the  spine  you  may  have 
a  soothing  effect  upon  those  nerves  and  thus  cause  them  to  relax.  What 
has  been  the  object  of  this  work?  Simply  this,  that  by  relaxation  of  the 
contracted  muscles,  or  by  stimulation  of  those  weak,  flabby  muscles,  you 
have  succeeded  in  drawing  new  life  to  that  spinal  column,  and  in  that 
way  you  have  made  your  first  step  toward  reinstating  the  strength  of  that 
debilitated  spinal  column. 

Q.  Is  a  simple  manipulation  there  enough  to  relax  the  contracted 
muscle? 

A.     Yes;  simple  manipulation  is  enough  if  rightly  applied. 

Q.     Is  a  dislocation  of  a  vertebra  liable  to  cause  giddiness? 

A.  It  may  very  readily.  It  may  act  in  such  a  way  as  to  shut  off  the 
blood  supply  to  the  brain. 

Q.     More  likely  the  cervical  vertebrae? 

A.  Yes ;  more  likely  in  the  cervical  region.  Or  it  might  act  in  such 
a  way  as  to  cause  retention  of  the  blood  in  the  head  and  result  in  dizziness. 

Q.  If  you  had  a  patient  who  was  unable  to  raise  his  hands  above  the 
level  of  the  shoulder,  and  there  was  pain  at  the  insertion  of  the  deltoid 
muscle  and  also  over  the  shoulders,  where  would  you  look  for  the  trouble? 

A.  I  would  look  for  the  trouble  in  the  brachial  plexus,  the  origin  of 
the  circumflex  nerve,  supplying  the  deltoid  muscle.  Also  look  to  the  scap- 
ular muscles  and  their  innervation. 


EXTERNAL   MANIPULATION    FOR   INTERNAL   RESULTS.  35 

LECTURE  VII. 

At  the  last  lecture  I  took  up  further  consideration  of  the  Osteopathic 
significance  of  points  found  in  diagnosis.  I  called  your  attention  to  the 
troubles  which  may,  in  general,  affect  the  lower  cervical  group  of  nerves, 
those  which  affect  the  brachial  plexus,  for  instance,  being  chiefly  spasms, 
neuralgias  and  paralysis.  Also,  I  called  your  attention  to  the  connection 
between  those  nerves  and  the  sympathetic  ganglia;  also  the  connection 
of  the  third  group,  the  dorsal  nerves,  except  the  twelfth,  with  the  sympa- 
thetic dorsal  ganglia;  the  diseases  of  this  group  being  chiefly  sensory.  I 
then  spoke  of  the  connection  of  the  fourth  group,  the  upper  four  lumbar 
nerves  and  the  last  dorsal,  being  connected  with  the  five  lumbar  ganglia 
of  the  sympathetic;  the  diseases  of  the  fourth  group  being  chiefly  neural- 
gias, and  not  spasms  or  paralysis,  although  you  might  find  them  in  that 
group.  Spasms  and  paralysis,  as  well  as  neuralgia,  being  more  commonly 
found  in  the  fifth  group ;  the  five  sacral  nerves  and  the  last  lumbar  being 
connected  with  the  sacral  sympathetic  ganglia.  I  also  traced  in  general 
the  connection  between  these  plexuses  and  diseases  which  might  originate 
there,  stating  that  my  object  in  the  last  two  lectures  had  been  to  aid  you 
to  keep  separate  the  cerebro-spinal  and  sympathetic  systems,  to  diagnose 
diseases  according  to  centers,  and  to  teach  you  to  separate  non-essentials 
from  essentials.  I  instanced  this  rule  of  nerve  force,  that  it  is  emitted 
along  the  path  of  least  resistance,  and  that,  sympathetically,  the  organ 
most  closely  connected  by  nerve-strands  with  the  organ  affected  is  most 
apt  to  suffer;  that,  in  the  sending  of  such  impulses  along  the  paths  of  the 
sympathetic  system,  certain  centers  such  as  the  abdominal  brain,  are  cen- 
ters for  reorganization  of  those  impulses,  so  that,  being  reflected  to  these 
centers,  they  are  sent  out  reorganized.  I  then  drew  some  illustrations  to 
account  for  phenomena  witnessed  according  to  this  law.  I  then  called  your 
attention  to  landmarks  concerning  the  scapula,  and  to  treatment  of  the 
spine.  That  being  the  question  you  naturally  ask  after  having  learned 
to  examine  the  spine.  The  general  points  brought  out  being  that  there 
is  a  treatment  upon  the  spine  itself,  and  a  treatment  of  the  spine  for  further 
reaching  effects,  chiefly  through  the  sympathetics,  upon  the  internal  vis- 
cera. And  I  showed  you,  by  laying  the  patient  upon  his  face  and  upon  his 
side,  what  was  the  technique  of  manipulation  that  we  employ.  I  shall,  in 
the  latter  part  of  this  lecture,  continue  that  subject.  I  have  thought  that 
for  the 'first  part  of  my  lecture  to-day  it  would  be  helpful  to  us  to  consider 
the  Osteopathic  theory  of  work  upon  centers. 

I.  HOW  DOES  THE  OSTEOPATH  BY  EXTERNAL  MANIPU- 
LATION UPON  THE  SURFACE  OF  THE  BODY  AFFECT  IN- 
TERNAL NERVE  LIFE?  How  can  he  reach  centers  in  the  spine,  or 
nerve  centers  in  any  part  of  the  body?  What  does  the  Osteopath  mean 


36  STIMULATION   AND   INHIBITION. 

when  he  says  that  he  stimulates  or  inhibits  nerve  action  ?  Those  are  great 
questions.  It  is  needless  for  me  to  say  that  they  lie  at  the  basis  of  our 
science.  It  is  not  a  question  as  to  fact.  The  facts  are  already  proven 
beyond  a  doubt,  but  it  is  a  question  of  finding  a  rational  scientific  explana- 
tion of  facts,  of  establishing  theories  which  lie  back  of  our  work.  Osteo- 
paths have  different  views  concerning  these  matters.  They  answer  these 
questions  differently.  I  called  upon  the  different  operators  in  the  building 
to  give  me  a  synopsis  of  what  their  views  were.  There  were  some  who 
said  they  were  not  able  to  explain  satisfactorily  some  of  these  things,  and 
there  was  also  some  disagreement  in  their  answers.  I  simply  wish  to  add 
my  little  mite,  not  at  all  supposing  that  it  will  solve  the  questions  for  all 
time.  There  are.  however,  certain  facts  in  relation  to  these  questions 
which  I  think  will  be  profitable  to  call  to  your  attention,  and  I  will  also 
make  some  reference  to  the  answers  which  L  have  received  from  the  old 
operators  whose  experience  has  been  wider  than  mine.  Remember,  it  is 
not  a  question  of,  "Do  you  do  this?  Do  you  accomplish  such  results?"  but, 
granted  that  the  results  are  accomplished,  which  is  true,  how  do  you  ac- 
complish them?  In  approaching  this  question  we  must  clear  away  all  mis- 
apprehension as  to  definitions.  Do  we,  when  we  say  "inhibition,"  etc., 
mean  the  same  as  the  physiologists  mean  when  they  say  inhibition,  stimula- 
tion, etc.,  and  can  we,  in  the  generally  accepted  view,  have  such  an  effect 
upon  the  nerve  as  to  inhibit  or  stimulate  them?  For  this  reason  I  will  first 
define  these  points  according  to  the  physiological  view,  and  then  accord- 
ing to  the  Osteopathic  view.  The  physiologist  uses  these  terms  in  two 
senses.  First,  in  the  usual  normal  sense;  a  normal  impulse  sent  from  a 
center  along  a  nerve  or  from  a  periphery  along  the  nerve,  resulting  in 
function.  For  instance,  an  impulse  is  sent  from  the  brain  along  a  nerve 
causing  the  contraction  of  a  muscle.  Again,  a  sensation  of  pain  comes 
from  the  periphery  to  the  center,  which  thus  receives  it,  and  there  is  a 
sense  of  pain.  In  this  case  there  was  a  stimulation  of  a  sensory  nerve  by 
the  agency  producing  the  pain,  no  matter  what  that  agency  was.  For  in- 
stance again,  the  normal  and  continuous  inhibition  of  cardiac  action 
through  the  vagi  by  the  impulse  sent  from  the  brain.  Now,  that  is  the 
normal  and  usual  sense  in  which  these  terms  are  used.  The  second  sense 
in  which  these  terms  are  used  by  physiologists  is,  irritation  of  a  nerve, 
and  thus  the  stimulation  or  inhibition  or  function  by  physical  agencies,  as 
heat,  cold,  electric  current,  application  of  pressure  or  tapping,  or  the  appli- 
cation of  chemicals.  That  is  what  they  mean  when  they  say  they  have 
acted  upon  a  nerve ;  have  experimentally  treated  a  nerve.  They  may,  for 
instance,  apply  a  caustic  and  elicit  a  sensation  of  pain,  and  state  that  they 
have  stimulated  the  nerve.  They  may  for  instance  again,  apply  an  electric 
current,  stimulate  the  nerve  and  cause  muscular  contractions.  Or,  finally, 
they  may,  by  pressure  or  tapping  upon  the  nerve,  carried  to  the  point  of 


THEORY  OF  OSTEOPATHIC  WORK  UPON  NERVES  AND  CENTERS.         37 

exhaustion,  secure  the  result  of  paralysis,  that  is,  inhibition  of  the  nerve 
action,  resulting  in  the  loss  of  sensation  or  of  motion,  or  of  both.  They 
then  say  that  they  have  "inhibited,"  desensitized  the  nerve.  They  thus 
by  the  use  of  physical  agencies  produce  such  results,  similar  to  the  normal, 
for  instance,  the  contraction  of  muscle,  and  reason  that  the  impressions 
aroused  by  such  agencies  are  similar  to  normal ;  they  have  really  stimu- 
lated, or  inhibited.  For  instance,  they  by  some  agency,  the  use  of  an  elec- 
'tric  current,  so  stimulate  the  periphery  of  the  sciatic  nerve  that  they  get 
a  vaso-motor  effect  in  the  nerve.  They  reason  that,  as  they  have  stimu- 
lated the  nerve  fibres  in  a  manner  similar  to  normal,  therefore  there  are 
sympathetic  vaso-motor  fibres  in  the  sciatic  nerve.  This  was  the  actual 
method  employed  in  determining  that  vaso-motor  fibers  'were  contained  in 
the  sciatic  nerve,  and  this  was  accepted  by  the  authorities.  I  believe  that 
I  have  thus  correctly  represented  the  views  of  the  physiologists  in  the 
definition  of  these  terms. 

Second— HOW  DOES  THE  OSTEOPATH  DEFINE  THESE 
TERMS?  What  does  he  mean  when  he  uses  them?  He  uses  them,  of 
course,  in  the  normal,  physiological  sense,  which  we  will  leave  aside.  He 
also  uses  them  in  another  sense,  which  for  the  present  we  will  leave  aside 
also.  But  the  question  to-day  is,  does  he  by  a  physical  agency,  that  is, 
'by  manipulation,  by  pressure,  by  tapping,  and  stretching,  all  of  which 
he  uses  in  effecting  nerve  filaments  or  nerve  centers,  produce  a  result 
similar  to  normal,  and  may  he  be,  with  the  physiologist,  allowed  to  rea- 
son that  therefore  the  impulse  which  he  has  aroused  by  the  use  of  such 
physical  agencies  is  similar  to  the  normal?  A  pressure  on  the  phrenic 
nerve  controls  the  spasm  of  hiccoughs.  The  result  of  the  use  of  such 
physical  agency  is  similar  to  normal,  hence  the  impulse  must  h:ive  been 
similar  to  normal.  Again,  by  rubbing  the  neck  in  the  region  of  the 
superior  cervical  ganglion,  he  stops  bleeding  from  the  nose,  and  pro- 
duces an  effect  similar  to  normal,  hence  the  vaso-motor  influence  gen- 
erated by  irritation  in  that  region  must  be  similar  to  normal.  He  says 
he  inhibited  the  phrenic  or  stimulated  the  superior  cervical  ganglion. 
We  must  allow  him  equally  with  the  physiologist  to  say  that  he  has 
stimulated,  or  inhibited  the  nerve  in  question.  Now.  the  question  at 
once  arises,  what  was  the  manner  of  the  application  of  those  physical 
agencies?  Does  the  physiologist,  as  well  as  the  Osteopath  apply  these 
agencies  externally?  Of  course  if  there  is  a  difference  in  application, 
then  our  reasoning  would  not  hold  good.  But  my  reply  here  is,  yes, 
he  applies  them  externally,  though  not  always.  Still,  if  he,  the  physiolo- 
gist, does  it  only  sometimes,  and  obtains  results  which  justify  him  in 
saying  that  he  has  really  stimulated  or  inhibited,  the  case  is  proven  for 
the  Osteopath,  even  though  the  latter  works  externally  always,  provid- 
ing only  that  the  Osteopath  obtains  as  wide  range  of  results  as  does  the 


38  THEORY   OF   OSTEOPATHIC   WORK   UPON   NERVES  AND   CENTERS. 

physiologist,  who  works  both  externally  and  upon  the  exposed  nerve 
or  center.  That  the  Osteopath,  by  his  means,  obtains  results  in  every 
part  of  the  body  is  shown  fcy  cases  upon  record. 

I  wish  to  quote  from  standard  texts  to  show  that  the  physiologist  does 
work  externally  upon  the  body  to  produce  his  results.  In  the  first  place, 
I  quote  from  Dr.  Lombard,  Professor  of  Physiology  in  the  University  of 
Michigan,  in  Howell's  American  Text  Book:  ''If  pressure  be  brought 
to  bear  on  the  ulnar  nerve  where  it  comes  across  the  elbow,  the  region 
supplied  by  the  nerve  becomes  numb."  Now,  in  the  context  he  explains 
that  everyone  has  occasion  to  demonstrate  this  upon  himself,  evidently 
implying  that  external  pressure  was  used.  W.  T.  Porter,  M.  D.,  Assistant 
Professor  of  Physiology  in  Harvard  Medical  School,  in  the  same  texx 
book  states  as  follows:  "The  reflex  action  of  the  sympathetic  nerve  upon 
the  heart  is  well  shown  by  the  experiment  of  F.  Goltz.  On  a  medium 
sized  frog  the  percardium  was  exposed  by  carefully  cutting  a  small  win- 
dow in  the  chest  wall.  The  pulsations  of  the  heart  could  be  seen  through 
the  thin  pericardial  membrane.  Goltz  now  began  to  tap  upon  the  abdomen 
at  the  rate  of  about  140  times  a  minute  with  the  handle  of  a  scalpel.  The 
heart  gradually  slowed  and  at  length  stood  still  in  diastole.  Goltz  now 
ceased  the  rain  of  little  blows.  The  heart  remained  quiet  for  a  time,  and 
then  began  to  beat  again,  at  first  slowly  and  then  more  rapidly.  Some 
time  after  the  experiment,  the  heart  beat  about  five  strokes  in  the  minute 
faster  than  before  the  experiment  was  begun.  The  effect  cannot  be 
obtained  after  section  of  the  vagi." 

I  have  thus  quoted  at  length  to  show  with  exactness  the  manner 
of  experimentation  and  the  external  application  of  this  physical  agency 
which  was  employed.  Again,  the  physician  in  applying  the  electric 
current  to  a  living  patient  for  the  purpose  of  diagnosis  or  treatment, 
applies  the  same  externally.  I  quote  from  Dana;  ''Statical  electricity 
is  applied  from  fifteen  to  twenty  minutes  daily  or  tri-weekly.  For  gen- 
eral tonic  or  sedative  effects,  sparks  are  drawn  from  all  parts  of  the  body 
except  the  face;  in  paralysis  or  spasms  of  pain,  sparks  are  applied  to  the 
affected  area.  In  general  electrization,  whether  galvanic  of  faradic,  the 
indifferent  electrode  is  placed  on  the  sternum,  feet  or  back,  and  the  other 
pole  is  carried  over  the  limbs,  trunk,  neck,  and  if  indicated,  the  head." 
In  course  of  the  argument  I  wish  to  instance  what  I  heard  Dr.  Eckley 
say  once  concerning  the  surgical  method  of  treating  sciatica.  He  said 
that  an  incision  was  made  through  the  gluteal  muscles  down  to  the 
nerve,  laying  it  open  to  view;  that  a  hook  was  then  used,  and  the  nerve 
stretched  with  a  force  about  forty  pounds,  that  is,  sufficient  to  raise  the 
toe  of  the  patient  from  the  table,  the  patient  lying  on  his  face.  That  was 
the  surgical  method  of  stretching  the  nerve  to  relieve  cases  of  sciatica. 
He  also  went  on  to  say  that  the  method  used  nowadays  is  that  of  flex- 


HOW   TO   TREAT   THE   SPINE. 

ing  the  thigh  upon  the  thorax,  thus  giving  a  strong  tension  to  the  nerve. 
That  is  the  treatment  used  to-day  by  physicians  for  the  cure  of  sciatica. 
You  will  see  that  that  was  external  manipulation,  that  the  application 
of  electrical  current  was  external,  the  tapping  upon  the  abdomen  was 
external,  and  the  pressure  upon  the  ulnar  nerve  was  external.  I  have 
simply  endeavored  to  show  that  the  Osteopath,  in  treating  nerves  ami 
centers,  employs  physical  agencies  externally.  In  one  case  the  physiolo- 
gist is  allowed  to  say,  and  it  is  accepted  by  the  authorities,  that  he  has 
stimulated  a  nerve,  stimulated  nerve  action  by  this  means,  and  inhibited 
nerve  action  by  this  means,  and  my  argument  is,  therefore,  that  in  the 
same  manner  the  Osteopath  must  be  allowed  to  say  that  he  has  stimu- 
lated or  inhibited  nerve  force,  and  that  we  therefore  use  these  terms  in 
the  generally  accepted  manner.  This  is  my  view  of  the  subject,  and  I 
believe  my  conclusions  are  reasonable  and  fair,  that  from  the  results 
accomplished,  means  employed,  and  manner  of  application  of  the- physi- 
cal agency  by  the  physiologist  and  by  the  Osteopath,  the  latter  is  as 
much  entitled  as  is  the  former  to  the  use  of  the  terms  stimulation  and 
inhibition  in  their  generally  accepted  sense. 

I  shall  follow  this  subject  further  for  a  lecture  or  two.  There  are 
many  points  in  relation  to  the  work  upon  nerve  centers  which  are  ob- 
scure, and  which  I  think  I  can  with  value  attempt  to  illustrate  before 
you. 

II.  HOW  TO  TREAT  A  SPINE.  (Continued.)— Whereas,  the  last 
time  I  gave  you  the  treatment  for  the  spine  itself,  to-day  I  will  take  up 
the  consideration  of  treatment  of  the  spine  for  distant  effects.  The  point 
here  is,  that  we  may  not  only  treat  the  spine,  with  the  patient  upon  his 
face,  for  immediate  effects  to  the  spine,  but  we  may  treat  to  reach  viscera 
through  the  sympathetic  nervous  system.  Your  first  object  is  to  relax 
all  the  structures,  as  in  the  other  case,  for  the  reason  that  tension  here 
in  the  muscles  may  affect  a  center,  it  may  affect  not  only  the  center 
which  relates  to  the  spine  itself,  but  a  center,  for  instance,  the  splanchnics, 
controlling  the  stomach,  or  the  kidneys,  or  the  bladder,  or  some  of  the 
internal  viscera.  You  will  very  commonly  find  sore  spots  along  the 
spine.  The  indication  is  usually  that  they  are  the  seat  of  lesions.  We 
reason,  then,  according  to  the  sore  spots,  or  according  to  the  contraction 
of  the  muscles,  or  according  to  the  separation  of  the  vertebrae,  or  what- 
ever the  lesion  may  be,  to  the  centers  of  the  sympathetic  affected.  If 
we  know  where  the  different  centers  are  situatd  along  the  spine,  and  find 
a  lesion  at  a  certain  point,  we  can  reason  what  the  result  would  be,  or 
vice  versa,  by  fiding  a  certain  disease  manifest  in  the  body  we  can  trace 
back  from  the  disease  to  the  center,  and  expect  to  find  a  lesion  at  or 
near  that  center.  For  instance,  suppose  I  had  examined  this  gentleman 
and  found  that  he  had  lung  trouble,  I  would  then,  according  to  Osteo- 


40  HOW   TO   TREAT   THE   SPINE. 


pathic  procedure,  go  back  to  the  centers  along  the  spine,  and  I  would 
look  from  the  second  to  *he  seventh  dorsal  for  a  lesion,  and  if  I  did  not 
find  a  lesion,  I  would  still  stimulate  in  that  region.  I  might  here  instance 
a  case  that  I  have  treated,  a  case  of  congestion  of  the  lungs  associated  with 
heart  trouble,  where  there  was  great  difficulty  of  breathing,  considerable 
pain,  accompanied  by  pallor  and  general  debility,  and  there  was  every 
indication  that  the  lungs  were  affected.  And  by  applying  not  more  than 
a -minute's  work  in  this  region,  from  the  second  to  the  seventh  dorsal 
on  both  sides,  the  patient  sitting  upon  a  stool,  I,  standing  behind,  rais- 
ing the  ribs  and  stimulating  the  centers,  got  a  good  effect.  Sometimes 
in  such  a  case  you  have  to  work  quickly,  and  in  some  cases  you  will 
find  that  it  will  not  do  to  have  the  patient  lie  down. 

If  I  should,  for  instance,  be  treating  this  gentleman  for  stomach 
trouble,  having  in  my  examination  and  in  my  conversation  with  him 
found  that  he  was  so  afflicted,  I  would  look  for  some  lesion  along  the 
spine  in  the  region  of  the  splanchnics,  from  the  sixth  dorsal  down  to  the 
twelfth  (especially  the  upper  splanchnics  for  the  stomach).  And  in  that 
event,  how  would  I  go  about  to  treat  him?  Simply  by  use  of  the  points 
which  I  gave  you  in  how  to  treat  the  spine.  I  would  loosen  the  spine, 
and  relieve  any  tension  in  the  ligaments  which  I  find,  I  would  stimulate 
the  muscles  all  along  in  this  region,  and  work  out  any  sore  spots,  and 
any  contracted  muscles.  This  contracture,  or  tightening  of  the  muscles, 
I  shall  go  into  deeper  in  the  course  of  a  lecture  or  two.  Thoroughly 
work  along  the  spine,  not  too  hard,  using  the  flats  of  the  fingers,  which 
requires  some  strength  in  the  muscles  of  the  forearm.  You  need  not 
be  afraid  of  the  patient,  you  need  not  be  afraid  to  apply  your  treatment 
thoroughly,  but  you  should  use  your  judgment  as  to  how  long  a  treat- 
ment you  should  give.  It  is  very  hard  to  say  anything  as  to  the  length 
of  time  of  treatment;  you  will  have  to  learn  that  for  yourselves.  Though 
in  general  a  young  Osteopath  will  treat  a  very  long  time,  and  an  old 
operator  will  treat  a  much  shorter  time. 

If  I  should  find  that  there  was  genital  trouble  or  trouble  with  the 
pelvic  viscera  I  should  naturally  look  along  the  centers  in  the  lumbo- 
sacral  region,  and  I  would  very  likely  find  a  lesion  at  the  fifth  lumbar, 
where  I  would  find  a  soreness.  In  that  case  I  would  relax  all  the  parts; 
I  would  bring  the  legs  up  against  me  and  get  a  close  application  of  the 
hand  to  the  affected  spot.  Then  holding  in  the  sacro-iliac  articulation. 
and,  by  lifting  up  against  it  allowing  the  weight  to  hang  down  from 
that  point,  I  spring  the  pelvis  and  bring  pressure  upon  these  ligaments, 
first  on  one  side  and  then  on  the  other,  relaxing  all  the  structures  around 
the  fifth  lumbar,  preparatory  to  reducing  any  slip  which  may  be  found 
there.  Suppose  there  was  not  a  slip  there  but  simply  a  sore  spot,  my 
object  would  be  then  to  work  out  the  sore  spot  and  thoroughly  relax 


SOW   TO   TREAT   A   SPINE.  41 

the  tension,     I  will  take  up  the  setting  of  the  slip  of  the  innominate  at 
another  time. 

In  the  examination  of  a  spine  we  may  find  a  vertebra  lateral  at  any 
point.  Suppose,  for  instance,  that  the  twelfth  dorsal  is  slipped  laterally, 
toward  the  right,  we  would  very  probably  find  that  the  sore  spot  was  on 
the  right  side,  as  the  sore  spots  in  the  muscles  are.  as  a  rule,  on  the  side 
to  which  the  spine  is  slipped,  though  it  may  be  on  the  other  side.  I 
would  first  treat  here  at  the  twelfth  dorsal,  loosening  the  muscles  about 
that  point.  How  do  I  know  when  I  have  done  enough  of  that?  In  general, 
when  you  find  a  more  relaxed  condition  there.  You  cannot  always  at 
the  first  treatment  relax  all  the  muscles;  you  will  find  cases  very  stub- 
born. I  have  treated  cases  where  the  muscles  would  relax  under  treat- 
ment but  would  contract  again  immediately.  It  will  depend  upon  the 
case,  but  work  a  reasonable  length  of  time  and  relax  all  parts  if  possible. 
After  I  have  relaxed  all  the  muscles  upon  the  right  side  ajbout  the 
twelfth  dorsal,  I  pursue  the  same 'Course  on  the  left  side;  then  go  deeper 
than  the  muscles  and  stretch  the  ligaments.  What  is  the  condition  of 
those  ligaments  when  the  spine  is  slipped  in  this  way?  I  have  shown 
you  in  a  previous  lecture  that  they  are  probably  all  upon  a  tension, 
some  forward  and  some  backward.  What  we  seek  to  do  is  to  spring  the 
spine.  By  springing  it  toward  you,  the  patient  lying  on  his  side, 
you  get  the  curve  above  and  thus  stretch  the  ligaments  on  this  side, 
then  turn  the  patient  over  and  go  through  the  same  process  upon 
the  other  side.  Now,  you  will  naturally  want  to  know  how  soon 
to  attempt  to  reduce  this  slip  of  the  vertebra.  Most  young  Osteo- 
paths when  they  find  a  dislocation  want  to  put  it  back  into  place  at  once. 
You  can  do  that  only  in  rare  cases.  In  a  recent  dislocation,  if  it  is  not 
very  serious  and  does  not  set  up  a  great  amount  of  inflammation,  it  may 
be  redxtced  at  once.  In  an  old  dislocation  you  will  have  to  work  a  con- 
siderable time  to  relax  all  these  parts,  throw  new  blood  and  nerve  force 
there  to  endow  them  with  new  vitality  which  they  have  been  lacking, 
and  you  will  have  to  learn  by  practice  to  work  a  sufficient  length  of  time 
before  attempting  to  set  a  vertebra.  There  are  several  methods  of  doing 
this.  One  of  the  best  is  to  first  EXAGGERATE  THE  CONDITION.  I  would,  in 
this  case,  have  my  patient  upon  a  stool,  the  spine  being  tipped  over 
toward  the  right,  I  bend  the  patient  so  as  to  exaggerate  the  condition, 
and  thus  bring  tension  upon  the  ligaments  upon  that  side.  I  have  be- 
fore brought  tension  upon  the  other  side  and  relaxed  everything  as  far 
as  possible,  and  by  working  the  patient  up  and  around  holding  against 
the  spine  of  the  vertebra,  I  in  that  way  slip  it  back  into  place.  It  does 
not  always  go  back.  You  will  perhaps  have  to  pursue  that  method  of 
treatment  for  a  considerable  length  of  time.  But  remember,  that  in 
setting  a  misplaced  vertebra,  in  general  the  method  is  to  exaggerate  the 


42     THEORY  OF  OSTEOPATHIC  WORK  UPON  NERVES  AND  CENTERS. 

condition,  and  that  you  then  work  in  just  the  opposite  way  and  throw 
the  curve  in  the  opposite  direction. 

.  Q.     I  do  not  understand  the  connection  of  the  5th  nerve  with  the 
pneumogastric. 

A.  The  pneumogastiic  supplying  the  stomach  is  affected  directly 
from  an  exciting  cause,  the  impulse  passes  along  the  pneumogastric 
going  directly  to  the  medulla,  which  is  the  center  for  all  of  these  nerves 
which  arise  from  the  floor  of  the  fourth  ventrical,  and  then  directly  out 
over  the  5th  cranial  nerve.  It  has  been  proved  that  an  impulse  can  be 
sent  from  a  nerve,  through  a  center,  and  out  over  another  nerve. 

Q.  In  referring  to  the  work  we  have  gone  over,  I  do  not  quite 
understand  why  a  click  in  the  neck  in  the  cervical  region  should  be  more 
serious  than  in  the  rest  of  the  spine. 

A.  Well,  I  so  stated  simply  because  it  has  been  my  experience  that 
I  could  find  these  noises  all  along  the  spine  when  they  mean  nothing  at 
all,  the  subject  being  perfectly  healthy.  While  in  the  cervical  region  it 
seemed  to  me  that  there  was  always  some  contraction  or  slight  break 
between  the  parts,  likely  enough  to  be  serious.  It  showed  that  the  blood 
supply  had  been  cut  off,  thus  diminishing  the  supply  of  lubricating 
material  in  the  synovial  membrane.  I  said  that  it  was  in  general  more 
serious,  because  my  experience  in  practice  seemed  to  bear  out  that 
point. 

Q.  In  the  case  of  a  lateral  displacement  of  the  atlas,  would  you 
exaggerate  the  condition  also? 

A.  Yes,  sir,  as  far  as  possible;  but  to  set  an  atlas  is  quite  a  technical 
matter.  I  will  take  that  in  detail  later. 

Q.  Suppose  there  was  a  spinal  curvature,  would  you  set  it  in  the 
same  way  you  would  a  single  vertabra? 

A.  In  that  case  you  would  use  the  same  general  method,  but  you 
would  begin  at  one  definite  point  and  try  to  set  it,  and  then  work  upon 
the  next  vertebra,  and  so  on. 


LECTURE  VIII. 

At  the  last  lecture  I  commenced  to  consider  the  Osteopath ic  theory 
of  work  upon  nerve  centers.  That  is  what  I  have  called  the  subject  in 
general,  although  it  includes  not  only  nerve  centers,  but  nerve  distribu- 
tion and  blood  supply;  how  the  Osteopath  works  by  external  manipula- 
tion upon  the  surface  of  the  body,  gaining  results  internally.  I  first 
defined  the  terms  stimulation  and  inhibition,  and  showed  that  while 
they  are  used  in  several  senses,  the  Osteopath  uses  them  in  the  usual 


THEORY   OF   OSTEOPATHIC   WORK    UPON    NERVES   AND   CENTERS.  16 

sense.  Our  conclusion  was  that  the  Osteopath  was  justly  entitled  to 
the  use  of  these  terms  stimulate  and  inhibit  nerve  action,  and  that  he 
works  in  the  same  manner  as  the  physiologist  when  he  is  experimenting 
upon  these  nerves.  That  since  the  physiologist,  gaining  results  which 
were  similar  to  normal,  reasons  that  he  has  therefore  affected 
the  nerves  in  a  manner  similar  to  normal,  the  Osteopath  should 
be  allowed  to  say  that,  since  he  has  gained  results  similar  to 
normal,  he  has  also  affected  the  nerves  in  a  normal  manner.  Taking 
away  the  sensitiveness  from  a  nerve,  or  the  excitability,  or  its  excited 
condition,  is  really  an  inhibition  of  nerve  force.  Or  it  may  amount  to 
this,  that  we  affect  the  conductivity  of  the  nerve,  and  that  is  what  I 
meant  by  the  use  of  the  word  desensitize.  We  then  are  privileged  to 
say  that  by  external  manipulation  we  have  really  stimulated  or  inhibited 
a  nerve.  If  we  have  worked  upon  nerves  and  upon  nerve  centers  in  that 
way,  we  have  produced  certain  results.  The  point  that  the  physiologist 
works  externally  only  sometimes,  while  we  work  outside  altogether. 
does  not  make  any  difference  with  the  argument,  from  the  fact  that  we 
have  as  broad  a  range  of  results  to  show  for  our  work  as  he  has  by  both 
external  work  and  work  upon  the  exposed  nerve.  I  think  that  my  posi- 
tion taken  at  that  time  was  sound. 

I.  THEORY  OF  OSTEOPATHIC  WORK  UPON  CENTERS. 
(Continued.) — Our  operators  agree  that  we  secure  direct  results  upon 
nerves  by  mechanical  work,  and  while  they  do  not  all  fully  agree  in  all 
they  say,  I  gather  from  the  communications  they  have  handed  me  that 
they  all  take  that  view  of  this  matter.  For  instance.  Dr.  McConnell 
says:  "We  affect  internal  nerve  action  by  manipulation  on  the  external 
parts  of  the  body,  by  a  general  mechanical  stimulation  given  to  the 
nervous  system."  He  says  further,  that  we  stimulate  or  ir-hibit  some- 
times, but  that  he  believes  there  is  a  general  misuse  of  these  term?,  and 
that  the  results  which  may  be  expressed  in  these  terms  are  not  often  the 
result  of  some  direct  inhibiting  or  some  direct  stimulating  v\crk  that  we 
put  upon  an  affected  point.  But  we  will  bring  that  point  up  when  I 
come  to  take  up  the  further  definition  of  these  terms  according  to  the 
Osteopathic  point  of  view.  Dr.  Harry  Still  says:  "We  inhibit  by  pressure 
or  by  holding,  thus  cut  off  nerve  action,  and  break  the  force  between 
the  brain  and  the  termination  of  the  nerve."  He  also  says  that  work 
outside  upon  the  body,  that  is  manipulation,  produces  a  direct  effect 
upon  the  nerves  through  pressure,  thus  affecting  sympathetic  life  through 
its  connection  with  the  spinal  nerves  or  their  centers.  He  instanced 
the  pneumogastric.  Mrs.  S.  S.  Still's  reply  shows  that  her  idea  is  that 
we  either  directly  or  reflexly  affect  nerves  or  centers  by  external  manip- 
ulation. Dr.  C.  M.  T.  Hulett  well  illustrates  in  part  the  theory  of  our 
work  as  follows:  "Pressure  upon  a  nerve  fibre  will  cause  a  break  in 


44  THEORY   OF   OSTEOPATHIC   WORK    UPON    NERVES   AND    CENTERS. 

the  continuity  of  the  semi-fluid  axis  cylinder,  and  if  abnormality  exists, 
then  the  ever  present  tendency  toward  the  normal  will  tend  to  restore 
normal  conditions."  I  understand  him  to  say  that  we  may  obtain  that 
result  by  pressure  upon  a  nerve,  by  external  manipulation,  which  is  the 
method  we  employ.  Dr.  Hildreth  and  Dr.  Charles  Still  both  have 
something  to  say  about  this.  I  could  not  get  their  communications 
to-day,  but  will  bring  them  later.  Thus,  as  you  see,  there  is  considerable 
unanimity  upon  this  point.  I  have  not  quoted  all  these  parties  have  to 
say,  but  I  shall  quote  from  them  to  explain  further  points  when  we 
come  to  them. 

Remember  that  this  is  not  the  only  effect  that  we  get  upon  nerve- 
centers  or  nerve  life,  this  mere  stimulation  or  inhibition  as  we  may  be 
privileged  to  call  it,  but  we  get  important  results.  I  leave  this  subjeet 
to  consider  a  different  point — there  are  other  means  at  the  Osteopath's 
command  by  which  he  may  affect  blood  and  nerve  force.  These  means 
are  important,  but  they  are  not  what  we  style  the  most  important  means 
at  our  command.  They  are,  however,  important  as  being  external,  non- 
medicinal  methods  of  reaching  deep  blood  and  nerve  force.  They  are 
not  distinctly  Osteopathic;  they  are  .simply  adjuncts  to  our  work.  One 
of  these  is  the  external  application  of  heat  or  cold.  Green,  in  his  Pathology, 
says:  "It  seems  that  vascular  dilation  of  deep  organs  may  be  produced 
reflexly  by  the  application  of  stupes  to  the  skin."  They  are  invaluable 
as  adjuncts  which  the  Osteopath  may  call  to  his  aid  if  necessary.  I  may 
instance  here  that  in  case  of  inflammation  following  some  injury,  you 
may  find  the  parts  so  swollen  as  to  make  it  impossible  for  you  to  deter- 
mine whether  or  not  the  parts  are  broken,  or  what  the  condition  really 
is.  You  will  frequently  find  that  in  such  cases  you  must  first  reduce 
the  swelling  before  you  can  apply  your  Osteopathic  work.  Not  to  say 
that  we  do  not  do  it  Osteopathically,  for  we  do.  In  the  case  of  a  swollen 
ankle  we  may  by  manipulation  of  the  venous  flow,  loosening  the  struc- 
tures about  the  femoral  vein,  aid  in  taking  down  the  swelling,  but  you 
will  find  that  if  such  cases  be  of  any  great  extent,  you  must  bring  in 
the  application  of  heat  or  cold;  you  will  have  to  use  fomentations  and 
the  applications  of  dry  heat  very  often,  and  it  is  always  advisable  to 
have  a  good  supply  of  hot  water  near  you  in  case  you  have  a  patient 
where  it  is  likely  to  be  necessary.  For  instance,  if  you  are  treating  a 
padent  for  some  disorder  and  he  is  continually  troubled  with  cold  feet 
while  lying  in  bed,  you  must  use  the  application  of  heat,  the  idea  being 
to  get  the  patient  as  comfortable  as  possible,  and  to  get  a  good  distri- 
bution of  blood  throughout  the  system;  also  to  prevent  collateral 
hyperaemia  on  account  of  having  too  little  blood  in  one  part.  I  think 
this  is  a  good  therapeutic  hint  for  the  Osteopath.  You  must  pay  atten- 
tion to  these  details,  or  some  such  little  thing  may  hinder  to  a  consid- 


THEORY  OF  OSTEOPATHIC  WORK  UPON  NERVES  AND  CENTERS.      45 

erable  extent,  the  results  you  are  trying  to  attain.  The  idea  is  to  equal- 
ize the  flow  of  blood  throughout  the  body.  The  application  of  cold  is 
frequently  useful,  though  we  do  not  use  it  very  often.  I  spoke  of 
fomentations;  that  is  a  term  applied  to  a  hot,  moist  application.  You 
will  frequently  find  it  useful  to  wring  out  a  cloth  in  hot  water,  as  hot 
as  can  be  borne,  and  apply  it  to  parts,  repeating  the  operation  frequently. 
This  is  a  fomentation,  while  dry  heat  is  applied  by  means  of  a  hot  water 
bag,  or  some  such  thing.  Bear  in  mind  that  these  things  are  good  in 
our  practice. 

You  may  also  get  a  VASO-MOTOR  EFFECT  BY  APPLICATION  OF  COLD.  Speak- 
ing of  renal  constriction,  HowelFs  Text  Book  says:  "The  same  effect 
(renal  constriction)  is  easily  produced  by  stimulating  the  skin,  for  ex- 
ample, by  application  of  cold."  Remember  that  we  as  Osteopaths  do 
not  depend  upon  the  use  of  these  agents,  but  I  call  your  attention  to 
them  as  valuable,  non-medicinal  adjuncts  to  our  practice,  and  also  as 
supporting,  by  quotations  from  the  standard  text  books,  the  contention 
of  the  Osteopath,  that  without  medication  the  blood  and  nerve  forces 
of  life  may  be  regulated  to  produce  health.  This  is,  too,  valuable  in 
our  arguments  with  medical  men.  It  all  tends  against  the  use  of  medi- 
cation. 

I  believe  that  the  Osteopathic  position  may  be  still  further  strengthened 
by  considering  the  effects  produced,  on  the  one  hand,  by  the  use  of  chemi- 
cals, drugs,  or  electric  currents,  and  on  the  other  hand  by  the  Osteopath 
in  his  use  of  mechanical  agents.  In  the  first  place,  drugs  and  clieinicals 
introduced  into  the  system  alter  normal  clicinical  conditions  in  which  flic 
nerve  must  be  in  order  that  its  normal  irritability  may  be  preserved.  In 
Howell's  Text  Book  it  is  stated  that  the  introduction  of  digitalis,  ether. 
alcohol,  water,  etc.,  changes  the  condition  of  the  irritability  of  the 
nerves.  "From  all  these  results  it  becomes  evident  that  the  normal 
irritability  of  nerves  and  muscles  require  that  a  certain  chemical  consti- 
tution be  maintained,  and  that  even  a  slight  variation  from  this  suffices 
to  alter,  and  if  continued,  to  destroy  the  irritability."  Now.  it  is  the 
physician,  and  not  the  Osteopath,  who  introduces  these  abnormal  chem- 
ical conditions,  thus  destroying  the  normal  irritability.  I' grant  the  force 
of  the  physician's  argument  when  he  says  that  he  supplies  these  drugs 
for  the  purpose  of  supplying  to  the  body  some  elements  which  are  lack- 
ing, but  I  doubt  whether  that  is  the  general  method  of  medication. 
Where  digitalis  is  given  to  retard  the  action  of  the  heart,  it  paralyzes  the 
nerves,  and  in  that  case  certainly  it  was  not  given  to  supply  the  lack  of 
some  such  constituent  in  the  system.  On  the  other  hand,  the  Osteopath 
does  not  introduce  any  of  these  foreign  substances.  He  stimulates 
nature,  and  nature  supplies  from  the  food  these  various  things  which 


46  INJURIOUS   EFFECTS   OF    DRUGS   AND   ELECTRICITY. 

are  needed  to  keep  the  normal  chemical  conditions  under  which  a  nerve 
or  muscle  is  normally  irritated. 

I  further  quote  from  Howell's  Text  Book  to  show  the  abnormal 
effects  of  electricity.  "Undoubtedly,  chemical  and  physical  alterations 
may  occur  in  nerves  as  the  result  of  the  passage  of  an  electric  current 
through  them,  and  it  would  seem  that  the  loss  of  conductivity  which 
they  show  when  subjected  to  strong  currents  is  to  be  accounted  for  by 
such  means."  "The  conductivity,  like  the  irritability  of  nerve  and  muscle, 
is  greatly  influenced  by  anything  which  alters  chemical  constituticn  of 
active  substance."  Hence  it  must  be  that  electricity,  chemicals  and 
drugs  produce  abnormal  changes  in  nerve  tissues.  Therefore,  I  main- 
tain that  the  Osteopath  may  secure  better  results  from  his  manipulation 
than  may  the  physician  by  medication;  for,  whereas  the  latter  introduces 
into  the  system  those  agents  which  by  their  nature  produce  abnormal 
changes  in  nerve  tissue,  the  Osteopath  introduces  no  foreign  matter. 
Moreover,  he  may,  through  his  manipulation,  attain  results  very  similar 
to  that  produced  by  normal  physical  exercise  of  parts  of  the  body.  I 
might  explain  here  the  effect  upon  the  nerves  of  an  athlete  in  stooping 
and  jumping.  He  may,  for  instance,  stoop  in  such  a  way  as  that  the 
thorax  is  bent  upon  the  thighs,  the  knees  touching  the  shoulders,  and  the 
sciatic  nerve  is  stretched,  just  as  we  stretch  it  in  sciatica.  There  are 
normal  exercises,  the  results  of  which,  if  we  can  judge  at  all,  are  ex- 
actly similar  to  results  we  obtain  by  giving  a  certain  motion  which  is 
in  our  stock  of  remedies,  we  might  say.  Thus  we  reason  concerning 
various  contractions  of  muscles,  motions  of  the  back,  bringing  pressure 
upon  the  garts  and  thus  keeping  them  stimulated  up  to  the  normal.  I 
think  that  the  similarity  is  readily  seen  between  normal  exercise  on  the 
one  hand,  and  the  application  of  Osteopathic  methods  on  the  other;  and 
the  difference  between  the  application  of  violent  means  such  as  the  use 
of  electric  currents,  chemicals  and  drugs,  and  the  application  of  normal 
exercise  to  the  parts  by  Osteopathic  manipulation.  In  the  treatment  of 
disease,  normal  exercise  differs  from  Osteopathic  treatment,  in  that  the 
Osteopath  has  the  patient  passive  in  his  hands  and  can  work  at  will. 
These  are  not  exercises  upon  his  part,  and  it  may  be  that  he,  being  ill, 
would  not  be  able  to  undergo  such  exercises  of  his  own  free  will. 

Remember  that  the  points  which  I  have  brought  out  have  been  ad- 
duced in  favor  of  the  argument  that  we  may  work  externaly  upon  the 
body,  and  thus  stimulate  or  inhibit  nerve  force.  But  we  do  not  consider 
that  the  most  important  part  of  our  work.  What  we  consider  more 
important  than  that  I  shall  take  up  when  I  come  to  describe  what  the 
Osteopath  means  in  the  second  sense  in  which  he  defines  these  terms, 
and  this  is  but  one  part  of  the  argument.  I  shall  at  the  next  lecture 
attempt  to  carry  this  line  of  thought  a  little  further  by  quoting  from 


HOW   TO   TREAT   A    SPINE.  47 

•• 

authorities  in  support  of  the  view  that  we  may  stimulate  or  inhibit  nerve 
force  by  external  work. 

II.  HOW  TO  TREAT  THE  SPINE.—  (Continued.)—  I  showed  you 
at  the  last  lecture  how  to  treat  a  spine  where  a  vertebra  was  displaced 
laterally.  To-day  I  want  to  show  you  how  to  proceed  when  you  find  the 
SPINES  SEPARATED.  If  by  examination  we  find  that  there  is  a  separation 
between  the  twelfth  dorsal  and  first  lumbar,  how  should  we  go  about 
to  rectify  the  condition?  In  such  a  case  our  method  of  reasoning  is 
that  there  is  a  lack  of  tone;  there  is  a  relaxation  of  the  ligaments:  we 
would  rather  expect  that,  though  it  is  not  necessarily  so.  Ai;d  in  that 
case,  we  would  first  go  about  to  restore  tone  to  all  the  parts  before 
proceeding  further.  I  need  not  go  over  the  same  ground  of  explaining 
to  you  that  you  thus  here  reach  the  central  distribution  of  the  sympa- 
thetics  all  about  this  part  which  is  lacking  in  tone,  but  in  this  case  that 
would  be  the  first,  and  you  might  almost  say  the  only,  step.  The  prob- 
abilities are  we  would  not  be  able  to  put  these  vertebrae  back  into  place 
at  once;  you  cannot  do  that  often.  Thoroughly  stimulate  and  loosen 
the  structures,  and  patiently  await  results,  and  you  will  gradually  see 
those  spines  coming  together.  So  that  your  best  method  is  to  stimulate, 
first  on  one  side  and'  then  on  the  other,  using  the  motions  I  have  given 
you,  bring  about  a  strengthening  of  those  parts.  You  need  not  work 
just  between  the  twelfth  dorsal  and  first  lumbar;  work  a  little  higher  and 
a  little  lower,  and  get  a  good  effect  all  about  the  parts.  Probably  this 
motion  of  getting  the  elbows  between  the  pelvis  and  shoulder,  and 
spreading  while  you  have  the  fingers  on  the  opposite  side  of  the  spines, 
and  springing  as  you  spread,  will  obtain  good  results. 

Q.  If  the  three  upper  lumbar  and  two  lower  dorsal  vertebrae  are 
posterior,  in  that  case  would  springing  the  spine  in  that  way  tend  to  bring 
it  back  to  the  proper  position  in  time? 

A.  Yes,  in  part.  I  shall  take  that  up  when  I  consider  variations 
from  normal  curves.  That  would  be  a  part  of  the  method,  however. 

Probably  I  would  have  the  patient  sit  up  on  a  stool  in  case  they 
are  separated.  You  can  separate  them  a  little  more.  Going  upon  the 
principle  of  exaggerating  the  defect,  spread  them  a  little  more,  thus 
allowing  a  stretch  and  a  recoil,  which  naturally  follows,  and  in  that 
way  throw  new  life  to  the  part,  and  then  we  seek  to  push  them  together. 
You  can  lift  up  and  push  down,  and  approximate  the  parts  in  that  way. 

Q.  In  the  lecture  reference  is  made  to  paralysis  without  loss  of 
sensation.  Do  we  ever  have  loss  of  motion  without  sensation? 

A.  Yes,  frequently.  You  will  find  that  in  your  practice,  loss  of 
motion  without  loss  of  sensation. 

Q.     Do  we  have  loss  of  sensation  without  loss  of  moticn? 

A.     Yes,  sir,  you  may  have  either. 


48  THEORY   OF   OSTEOPATHIC   WORK    UPON    NERVES   AND   CENTERS. 

Q.     Is  epilepsy  caused  by  displacement  of  the  vertebrae? 

A.  Very  frequently  caused  by  displacement  of  one  of  the  upper 
cervical  vertebrae;  we  find  it  so  in  our  practice. 

Q.  You  were  speaking  of  stimulating  the  circulation  in  the  feet 
by  the  application  of  dry  heat.  Is  there  any  practical  Osteopathic  treat- 
ment for  cold  feet? 

A.  Yes;  but  in  case  you  have  a  severe  case  of  cold  feet  it  would 
be  very  difficult  to  at  once  throw  enough  blood  to  those  feet  to  warm 
them  in  case  the  patient  were  very  sick.  You  could  not  adopt  measures 
strong  enough  on  account  of  the  general  debility  of  the  patient.  But 
I  will  say  this,  that  condition  yields  gradually,  as  do  a  great  many  other 
things,  to  treatment,  and  people  I  have  known  who  had  been  troubled 
with  cold  feet  for  years  would  find,  after  a  course  of  treatment  of  a 
month  or  more,  that  they  were  no  longer  troubled  in  that  wa.y;  that 
the  general  circulation  was  better  than  it  had  been  for  years. 


LECTURE   IX. 

At  the  last  lecture  I  considered  further  the  theory  of  Osteopathic 
work  upon  centers,  and  briefly,  to  recapitulate,  these  were  the  points  I 
took  up:  First,  that  our  operators  agreed  in  the  use  of  these  terms, 
stimulation  and  inhibition  in  general,  although  there  is  some  difference 
in  the  reservations  they  make.  I  also  quoted  from  different  ones  of 
our  operators  to  show  their  opinions  in  the  matter.  I  then  called  your 
attention  to  the  fact  that  that  was  not  the  only  way,  nor  yet  the  most 
important  way  in  which  we  considered  these  terms;  that  there  are  other 
means  by  which  the  Osteopath  may  command  deep  nerve  force  and 
blood  flow,  by  the  application  of  heat  and  cold,  which,  while  not  being 
distinctly  Osteopathic  methods,  are  yet  at  the  Osteopath's  command, 
and  serve  to  strengthen  our  argument  that  these  forces  of  life  can  be 
reached  from  the  external  surface  by  proper  methods,  without  medica- 
tion. I  quoted  from  authorities  to  substantiate  these  points.  In  gen- 
eral, the  application  of  heat  is  better  than  cold.  I  compared  the  effects 
produced  upon  the  nerves  by  chemicals  and  by  electric  currents,  as 
producing  a  certain  change  in  a  nerve,  producing  a  certain  change  in 
the  chemical  conditions  under  which  a  nerve  must  be  normally  in  order 
to  be  normally  irritable,  and  so  I  reasoned  that  Osteopath's  practice 
was  the  more  rational,  since  he  does  not  introduce  these  foreign  things 
into  the  system.  Further,  I  called  your  attention  to  the  similarity  of  the 
effects  of  Osteopathic  work  upon  the  body,  and  the  effects  on  the  body 
of  normal  exercise;  the  difference  being,  in  part,  that  your  patient  being 
sick,  is  not  able  to  undergo  these  physical  exercises,  while  in  your 


THEORY   OF    OSTEOPATHIC   WORK    UPON    NERVES   AND    CENTERS.  49 

hands  he  is  passive,  and  these  effects  may  be  given  without  the  fatigue 
which  would  accompany  his  own  exertion.  To-day  I  continue  the  con- 
sideration of  this  subject. 

I.  THEORY  OF  OSTEOPATHIC  WORK  UPON  NERVE 
CENTERS. —  (Continued.) — The  arguments  advanced  in  the  last  lecture 
may  be  strengthened  by  quotations  from  standard  text  books.  Having 
shown  that  the  Osteopath,  by  means  peculiar  to  his  system  of  treatment, 
accomplishes  results,  through  stimulation  and  inhibition  of  nerve  action, 
that  are  as  worthy  of  being  considered  normal  results  as  those  accom- 
plished by  physiologists,  through  methods  pursued  by  them  in  experi- 
mentation; having  shown  further,  that  the  Osteopath  accomplishes  such 
normal  results  in  every  part  of  the  body,  there  being  cases  upon  record 
to  prove  that  that  is  the  fact,  it  therefore  at  once  becomes  apparent  that 
the  whole  field  of  nerve-force,  controlling  directly  or  indirectly  every  mo- 
tion or  function  of  life,  lies  open  to  the  Osteopath;  that  wherever  there 
lies  a  nerve  of  the  body  capable  of  stimulation  or  inhibition,  it  is  his 
to  command,  providing  only  that  such  nerve  may  be  reached  by  Oste- 
opthic  methods,  either  directly,  as  through  pressure,  or  indirectly,  as 
through  the  blood  supply.  For  stimulation  is  stimulation,  and  inhibition 
is  inhibition.  It  makes  no  difference  in  fact._  I  will  grant  that  there  may 
be  a  difference  of  degree  of  stimulation  or  of  inhibition.  However,  hav- 
ing shown  that  the  Osteopath  stimulates  or  inhibits  just  as  really  as 
does  the  physiologist,  the  question  of  the  degree  of  stimulation  becomes 
a  secondary  one,  and  one  relative  only  to  the  point  in  view.  Results 
obtained  in  the  cure  of  diseases  in  every  part  of  ;he  body,  and  of 
almost  every  known  form  of  curable  disease,  show  conclusively  that 
the  Osteopath  has  really  stimulated  or  inhibited  nerve  force  according 
to  the  end  which  he  has  in  view.  It  would  be  no  argument  to  say  to 
an  operator  that  he  could  not  stimulate  enough  to  cause  a  man  to  jump 
over  a  table.  His  fitting  reply  would  be  that  such  was  not  the  end  in 
view;  that  the  end  in  view,  perhaps,  was  the  stimulation  of  a  flagging 
circulation  to  restore  it  to  its  normal  force  and  activity,  and  that  he 
very  readily  accomplished  that  result.  So  degree  of  stimulation  really 
makes  but  little  difference  to  us,  granted  that  we  have  gained  results. 
I  believe  that  there  is  no  nerve  of  the  body  that  the  Osteopath  may  not 
reach  by  proper  manipulation,  eiflier  directly  or  indirectly,  by  pressure. 
by  correction  of  lesion,  by  removal  of  obstruction,  or  by  control  of 
blood  supply.  What  that  fully  means  we  shall  see  as  the  subject  is  de- 
veloped. 

Now,  for  further  argument.  In  view  of  the  above  facts  it  is  inter- 
esting to  note  the  following  quotations  from  authorities  as  confirmation 
of  the  claims  of  the  Osteopath,  since  the  authorities  have  made  use  of 
such  means  as  has  the  Osteopath  to  produce  effects  upon  nerve  action. 


50  THEORY  OP   OSTEOPATHIC  WORK   UPON   NERVES  AND   CENTERS. 

Speaking  of  an  experiment  upon  the  ear  of  a  rabbit,  Kirk  says:  "Di- 
vision of  the  cervical  sympathetic  produces  an  increased  redness  of  the 
side  of  the  head,  and,  looking  at  the  ear,  the  central  artery  with  its 
branches  is  seen  to  dilate  and  become  larger,  and  many  similar  branches, 
not  previously  visible,  come  into  view.  The  dilatation  following  section 
can  be  demonstrated  in  a  very  simple  way,  by  pressing  the  nail  of  one 
finger  upon  the  nerve  where  it  lies  by  the  side  of  the  central  artery 
of  the  ear."  So  that  you  see  that  the  application  of  the  external  force, 
in  Kirk's  opinion,  is  equal  to  section  of  the  nerve.  Again,  from 
Green's  Pathology,  speaking  of  the  vaso-tonic  action  of  the  sympathetics, 
the  author  says:  "The  reflex  process  is  generally  due  to  stimulation  of 
sensory  nerves,  the  diminution  in  tonus  produced  being  more  or  less 
accurately  confined  to  the  region  supplied  by  the  nerve.  Friction  and 
slight  irritants,  in  the  early  stages  of  their  action,  produce  hyperemia  in 
this  way."  Thus  you  have  another  illustration  of  the  application  of  an 
external  mechanical  agent,  that  is  friction.  You  thus  set  up  a  reflex 
action.  I  shall  consider  that  further  when  I  apply  this  argument  to  work 
on  the  centers.  I  quote  further  from  Howell's  Text  Book:  "A  sudden 
pull,  pinch,  twitch,  or  cut,  excites  a  nerve  or  muscle.  All  have  experi- 
enced the  effect  of  mechanical  stimulation  of  a  sensory  nerve  through 
accidental  pressure  on  the  ulnar  nerve  where  it  passes  over  the  elbow, 
'the  crazy  bone.'  "  Speaking  of  their  irritability,  the  same  text  book 
says:  "Stretching  a  nerve  acts  in  a  similar  way,  for  this  is  also  a  form 
of  pressure,  as  Valentine  says,  the  stretching  causes  the  outer  sheath  to 
compress  the  myelin,  and  this  in  turn  to  compress  the  axis  cylinder." 
This  is  a  common  mode  of  our  treatment,  as  we  flex  the  limb  upon  the 
thorax  strongly  in  order  to  stretch  the  sciatic  nerve,  that  being  a  part 
of  the  treatment,  and  there  are  certain  movements  we  adopt  to  stretch 
the  brachial  plexus  in  nervous  affections  of  the  arm.  I  quote  further 
from  the  same  source:  "A  reflex  fall  in  blood  pressure  is  also  produced 
by  a  mechanical  stimulation  of  the  nerve  endings  in  the  muscle."  This, 
then,  was  a  mechanical  means,  and  the  fact  that  we  can  thus  work  on 
nerve  endings,  which  of  course  occur  all  over  the  body  in  the  muscles, 
gives  to  us  a  fruitful  field  for  the  application  of  external  manipulation. 
A  little  further,  Howell's  Text  Book  says:  "Both  the  sympathetfc  and 
vagus  nerve  fibres  have  their  influence -over  the  heart  decreased  by  cold 
and  increased  by  heat."  Now,  having  made  these,  quotations,  allow  me 
to  call  your  attention  again  to  the  fact  that  I  have  quoted  thus  fully  for 
the  purpose  of  showing,  out  of  the  mouths  of  the  authorities,  the  fact 
that  the  blood  and  nerve  supply  may  be  regulated  by  external  manipula- 
tion. I  have  quoted  them  for  the  sake  of  the  argument,  not  for  the 
purpose  of  giving  license  to  our  practice,  because  we  demand  license 
only  from  the  results  which  we  have  attained.  Nor  by  the  above  quota- 


HOW  TO   TREAT  ">    SIMM  E,  5} 

tions  which  I  have  made  do  I  intend  to  yield  a  point  and  say  that  the 
Osteopath  can  attain  only  such  results  upon  nerve  action  as  is  attained 
by  physiologists  by  external  manipulation,  because  I  believe  that  I  have- 
shown  that  the  conclusion  is  fair  that  the  Osteopath  can,  by  his  method, 
affect  any  nerve  in  the  body.  Hence,  I  shall  deem  it  competent  to  give 
you  vaso-motor  centers,  etc.,  with  the  understanding  that  the  Osteopath 
has  a  right  to  regard  all  such  as  legitimate  objects  of  treatment,  as  his 
facts  revert  to  in  argument,  and  as  his  equipment  for  work  in  the 
eradication  of  disease.  As  I  said,  the  more  important  part  of  how  the 
Osteopath  stimulates  or  inhibits  is  still  to  come,  and  I  shall  pursue  this 
subject  for  a  lecture  or  two  further.* 

HOW  TO  TREAT  A  SPINE— (Continued.)— At  the  last  lecture  I 
attempted  to  show  you  how  we  reason  and  work  in  case  the  spines  were 
separated.  In  to-day's  lecture  I  wish  to  take  up  the  question  of  how  we 
would  work  in  case  the  SPINES  WERE  APPROXIMATED.  That  is,  how  would 
we  separate  those  spines?  If,  in  passing  your  fingers  down  the  spine 
you  come  to  some  place  where  the  spines  of  the  vertebrae  are  too  close 
together,  and  this  is  a  very  common  lesion,  your  reasoning  in  that  case 
would  be  that  there  has  been  some  injury  at  that  point,  to  the  spine. 
perhaps  a  sudden  jerk  or  a  twist,  which  had  resulted  in  irritation;  too 
much  life  in  the  form  of  nerve  and  blood  force,  had  been  thrown  there, 
resulting  in  a  thickening  of  these  ligaments,  thus  contracting  and  bind- 
ing those  parts  together.  When  you  come  to  study  pathology  you  will 
find  that  any  irritation  sufficient  to  set  up  an  inflammation  is  very  likely 
to  be  followed  by  the  formation  of  new  connective  tissue  or  the  thicken- 
ing of  the  existing  tissues.  Reasoning  that  too  much  force  has  been 
directed  to  these  parts,  our  work  is  to  overcome  the  results  of  such 
misdirection  of  energy.  We  set  about  to  do  it  largely  by  the  same  man- 
ipulation as  we  would  adopt  in  the  case  of  approximating  spines,  at 
least  in  the  first  stages.  We  would  loosen  all  the  parts,  very  likely  you 
would  find  a  tension  in  the  ligaments  at  these  points  as  well  as  in  the 
muscles.  Having  loosened  all  the  muscles,  we  would  then  spring  the 
spines  upward,  getting  this  stretching  motion  that  I  have  before  de- 
scribed. I  would  work  with  sufficient  force,  according  to  the  patient. 
to  stimulate  these  parts  and  set  up  as  free  action  as  possible.  You  can 
then  operate  by  flexing  the  knees  up  against  your  own  body,  and  get 
considerable  purchase  upon  such  a  point  as  that,  and  while  it  is  rather 
a  strained  position  for  the  operator,  and  I  cannot  say  that  it  is  always 
comfortable  for  the  patient,  it  is  a  very  good  way  to  work,  because  you 
have  your  patient  in  such  a  shape  that  you  will  hardly  injure  him  by 
lifting  him,  as  I  have  done,  fairly  off  of  the  table.  By  this  method  you 
may  use  considerable  force,  but  of  course  you  must  not  be  rough. 

*See  appendix  4. 


i  '5Q  ^;  5  ^REAJrMiW  OF  THE  SPINE. 

U3arti';:  -  cti  ;\KMc\  <;^ 

I  spoke  to  you  about  a  SMOOTH  SPINE,  meaning  .a  spinal  column  which 
showed  all  along  it  that  the  spines  were  approximated  and  bound  down 
close  together.  Now,  you  have  a  variable  condition  there,  it  may  be  so 
bound  together  that  it  will  be  quite  rigid,  or  it  may  be  capable  of  con- 
siderable motion,  but  having  this  peculiar  smooth  feeling  all  the  way, 
so  as  to  lead  you  to  suspect  some  trouble.  I  have  had  a  number  of 
cases  of  that  kind  where  the  whole  spine  was  in  that  condition,  or  some 
one  particular  part  of  it,  and  almost  invariably  there  was  a  history  of 
some  strain,  or  jolting,  or  twisting  that  had  set  up  an  irritation  along 
the  spinal  column,  and  had  resulted  in  a  tightening  of  the  ligaments, 
which  has  resulted  in.  the  approximation  of  the  vertebrae.  In  such  a 
case  the  manipulation  would  be  largely  as  I  have  shown.  I  would 
loosen  first  the  muscles  along  the  spine,  remembering  to  work  against 
the  grain  of  the  muscle,  of  course  working  on  both  sides.  A  good  way 
to  do  that  is  by  the  motion  I  gave  you  with  the  patient  on  his  face;  you 
can  exert  considerable  force,  and  as  he  is  relaxed  you  can  loosen  muscles 
very  nicely.  Having  done  that  I  would  proceed  to  spring  the  spine  along 
its  various  parts.  By  flexing  the  knees  you  can  spring  the  spine  in  the 
lumbar  region,  and  by  using  the  arm  as  a  lever  you  can  spring  the  spine 
in  the  upper  region.  Of  course  it  is  rather  difficult  to  spring  the  spines 
between  the  shoulders.  One  good  way  to  work  there  is  to  get  the 
elbow  against  you,  and  work  along  the  spine  by  holding  and  stretching, 
your  object  being  to  loosen  all  of  these  ligaments  and  to  relax  what- 
ever is  holding  the  spines  together. 

As  to  the  misdirection  of  energy  resulting  in  their  being  bound 
together,  it  may  of  course  be  entirely  possible  that  at  this  present  time 
there  is  not  a  misdirection  of  energy,  but  there  has  been,  whether  past 
or  present,  it  does  not  make  a  great  deal  of  difference.  The  misdirected 
energy  may  have  acted  for  a  time  sufficient  to  thicken  and  perhaps  to 
contract  the  ligaments,  and  then  have  been  diffused  to  other  parts  of 
the  body,  so  that  this  may  be  an  old  result  without  there  being  at  present 
any  misdirected  energy  or  life  at  the  point  of  lesion. 

I  would  then  have  the  patient  on  his  back  and  would  stretch  the 
lower  part  of  his  spine  by  taking  one  of  his  limbs  and  my  assistant 
the  other,  and  working  both  limbs  up  toward  the  chest,  thus  getting  a 
purchase  on  the  lower  part  of  the  spine.  You  are  not  very  likely  to 
hurt  the  patient,  but  you  must  be  careful  because  different  people  are 
different  in  'that  respect,  and  you  may  do  considerable  hurting,  if  not 
actual  damage,  in  that  way.  Again,  if  you  have  such  a  case,  you  should 
bring  traction  on  the  spine  rs  much  as  possible:  and  it  is  a  very  good 
way  also  to  take  hold  of  the  patient  by  the  occipital  protuberance  and 
the  inferior  maxillary,  and  to  exert  traction  enough  to  draw  the  patient 
along  the  table.  You  are  not  likely  to  hurt  the  patient  with  that  degree 


TREATMENT   OF   THE   SPINE.  53 

of  force,  unless  it  be  a  delicate  lady.  Remember  that  you  have  already 
sprung  the  spine  by  working  all  along  on  each  side.  One  precaution 
you  must  observe  when  you  have  the  neck  extended  in  this  way, 
remember  that  the  neck  is  less  supported  than  the  other  parts  of  the 
spine,  and  if  you  should  twist  at  that  time  you  might  cause  a  dislocation, 
the  articular  processes  might  slip  out  of  place,  so  it  is  advisable  not 
to  turn  when  you  have  it  extended.  If  you  wish  to  turn  the  neck,  do 
it  when  the  spine  is  not  under  traction.  In  order  to  be  thorough  the 
treatment  must  be  applied  to  the  whole  length  of  the  spine,  and  when 
you  had  the  patient  upon  his  face  you  would  have  loosened  up  the 
muscles  along  the  lower  regions  of  the  spine,  the  sacrum  and  coccyx. 
You  may  get  considerable  force  by  putting  the  knee  against  the  sacro- 
iliac  articulation  and  springing  the  pelvis.  You  must  relax  all  the 
ligaments,  you  should  loosen  all  about  it  as  well  as  further  above.  Re- 
member that  your  work  has  been  to  loosen  parts  which  through  mis- 
directed energy  have  been  drawn  together.  When  you  have  such  a 
condition  you  may  have  almost  any  result,  that  is.  results  affecting  the 
body  through  the  nerves  in  almost  any  way.  As  a  general  rule,  I  think 
you  will  find  that  the  results  may  not  be  marked,  but  may  be  general, 
and  you  may  have  a  case  of  general  malnutrition,  or  neurasthenia,  or 
something  of  that  kind. 

I  would  set  the  patient  on  a  stool,  and  use  the  motion  I  showed 
you  at  the  last  lecture,  then  you  can  get  hold  along  the  spine,  generally 
it  is  better  to  work  from  the  bottom  up,  though  it  does  not  make  much 
difference;  I  hold  there,  bend  back  a  little  and  exert  traction  as  I 
ascend  the  column.  That  is  a  very  good  way.  You  may  produce  the 
same  result  and  I  think  get  a  little  better  stretching  motion  by  taking 
a  turn  as  you  work,  you  would  be  more  likely  then  to  stretch  all  the 
ligaments  about  the  vertebrae. 

In  case  you  have  a  SPINE  MISPLACED  ANTERIORLY,  you  will  have  some- 
thing which  is  rather  difficult  to  deal  with.  In  such  a  case  you  must 
depend  largely  upon  the  effects  of  the  general  strengthening  which  you 
give  to  the  parts  to  work  the  spine  out  into  its  normal  position,  as 
you  must  in  other  cases  also.  .But  when  you  have  the  spine  anterior,  it 
is  very  difficult  to  get  hold  of  the  vertebra,  or  to  influence  it.  However, 
Mrs.  Dr.  Patterson  makes  a  point  of  getting  hold  of  the  spine  as  much 
as  possible  and  working  at  it.  In  case  of  dislocations  of  cervical  ver- 
tebrae, it  is  a  good  point  to  examine  internally,  and  when  the  disloca- 
tion is  considerable  you  may  find  a  protrusion  into  the  pharynx.  In 
such  a  case,  you  would:  use  not  only  the  method  I  told  you  of.  trying 
to  reach  the  spine,  but  would  thoroughly  manipulate  every  point  about 
it,  and  would  spring  it  each  way.  There  is  one  other  method  that  I 
think  would  be  helpful;  that  is,  your  spine  being  anterior,  and  going 


54  TREATMENT  OF  THE   SPINE. 

upon  the  principle  that  we  sometimes  adopt  of  exaggerating  the  defect, 
you  could  bend  the  patient  backward,  and  by  placing  the  knee  in  the 
back  and  raising  the  arms  above  the  head  (you  must  be  careful  with 
this  motion),  you  would  exaggerate  the  defect,  it  would  loosen  the  liga- 
ments along  the  anterior  part  of  the  spine  which  are  already  stretched, 
and  which  you  wish  to  stretch  a  little  more  in  order  to  get  the  effect 
of  the  recoil,  and  then  by  relaxing  and  allowing  the  patient  to  (bend 
forward  again  you  get  the  recoil.  Then  there  is  another  point  which 
I  think  will  be  helpful  to  you;  it  is  practically  the  same  as  I  showed 
you.  As  you  work  along  the  spine,  the  idea  is  that  you  get  the  bodies 
of  the  vertebrae  to  move  one  upon  the  other.  You  get  the  same  result 
as  when  you  move  your  body  by  working  your  feet  along  the  floor.  I 
think  you  may  very  readily  get  such  a  result  by  working  the  bodies  of 
the  vertebrae  one  against  the  other. 

In  case  there  is  a  SPINE  POSTERIORLY,  what  would  you  do?  I  take  up 
these  points  in  detail  as  I  went  over  them  in  examination  of  the  spine, 
although  the  method  of  treatment  is  largely  the  same.  If  the  spine  is 
posterior  you  would  bend  your  patient  forward  to  exaggerate  the  defect, 
and  then  you  could  turn  him  to  either  side  and  get  the  effects  of  the 
recoil  by  pushmg  him  backward.  Of  course  in  such  case  you  -nust  be 
careful  not.  to  use  too  much  force  and  not.  to  strain  the  parts  beyond 
what  they  would  normally  stand. 

In  examination  of  the  spine  I  spoke  to  you  concerning  the  liga- 
mentum  nuchns,  and  the  importance  it  sometimes  bears  in  our  treat  - 
ment  of  the  spine,  mentioning  the  fact  that  I  have  often  found"  cases 
of  headache  which  would  yield  to  treatment  only  when  the  ligamentum 
nuchse  was  relaxed.  By  carefully  examining  along  the  furrow  just 
below  the  occipital  protuberance  you  may  find  that  the  ligament  is 
tense;  you  may  find  that  it  presents  a  firm  resistance  to  the  hand.  The 
patient  can  also  feel  it  by  stretching  the  head  forward;  he  will  feel  that 
the  ligament  is  tense.  Naturally,  in  projecting  the  head  forward,  on.* 
should  not  feel  a  sense  as  of  a  check  rein  there,  but  in  case  of  cold  I 
have  frequently  found  it  distinctly  upon  myself,  have  felt  a  sense  of 
tightness  along  the  region  of  the  neck,  and  by  examination  with  the 
hand  I  came  to  the  conclusion  that  there  was  no  other  reason  for  the 
trouble  than  that  the  ligament  was  tense,  and  that  was  really  the  fact. 
The  way  to  stretch  that  ligament  is  very  simple.  I  usually  flex  the 
head  directly  upon  the  thorax,  admonishing  the  patient  to  lie  with  his 
weight  down,  to  let  his  weight  fall  against  my  hands,  and  I  raise  the 
head  with  sufficient  force  to  raise  the  shoulders  off  the  table.  That 
would  be  a  good  movement  to  adopt  in  stretching  of  the  spine  when 
the  whole  spine  was  smooth  or  tense.  That,  together,  with  flexing  of 
the  two  knees  against  the  shoulders,  would  make  a  very  good  extension 


TREATMENT   OF   THE   SPINE.  55 

movement.  In  such  a  case  of  tightening  of  the  spine  it  is  a  good  idea 
to  advise  your  patient  to  hang  himself,  not  literally,  but  to  catch  hold 
of  his  closet  shelf  or  the  top  of  the  door  jamb,  and  bring  the  weight  of 
his  body  upon  his  arm  muscles.  That  would  tend  to  relax  the  spine, 
and  it  is  a  very  good  way  to  relax  the  lumbar  portion  of  the  spine,  as  it 
is  not  so  much  supported  by  attachment  to  the  shoulders  as  the  upper 
parts  of  the  back,  from  the  twelfth  dorsal  up.  I  have  often  heard  Dr. 
Harry  Still  advise  some  such  stretching  motion. 

Q.     When  you  have  relaxed  the  structures  along  a  smooth  spine, 
would  you  give  the  stretching  treatment  at  the  same  treatment? 
A.     Yes,  sir. 

Q.  In  the  case  of  a  vertebra  being  anterior,  placing  the  knee  on  the 
spine,  would  you  put  it  above  or  below  the  vertebra  that  was  anterior? 
A.  Well,  generally  just  about  that  point.  You  regulate  your 
force,  and  I  do  not  think  you  are  in  any  danger  of  pushing  it  forward, 
but  the  general  idea  there  is  not  to  bring  pressure  upon  that  point,  so 
much  as  to  give  a  fulcrum  against  which  to  work,  and  let  the  general 
tendency  of  the  forward  motion  of  the  spine  do  the  work. 

Q.  Would  stretching  the  ligamentum  nuch;e  have  a  tendency  to 
get  posterior  curvature  out  between  the  shoulders? 

A.  Partly  so,  though  we  do  not  usually  pursue  that  method  for 
that  particular  thing.  It  would  help. 

Q.  In  stretching  the  ligamentum  nuchae  forward,  is  there  any 
danger  of  acting  upon  the  nerves  that  go  to  the  stomach? 

A.  I  have  never  found  any  trouble  in  that  way.  I  hardly  think 
there  would  be,  unless  in  case  of  defect,  as  you  thus  stretch  the  whole 
spine,  you  might  get  an  effect  upon  the  -planchnics. 

Q.  In  case  of  anterior  displacement  of  the  4th  cervical,  would  the 
stretching  of  the  ligamentum  nuchae  have  a  tendency  to  draw  it  out? 

A.  It  would  not  have  much  of  a  tendency  to  do  that.  It  is  true 
there  are  slips  that  run  down  to  those  vertebrae,  but  you  would  hardly 
get  enough  tension  by  those  slips  to  bring  tension  upon  the  vertebrce. 

Q.  In  separation  of  the  spines  there  is  a  weakness  of  the  ligaments, 
and  in  approximation  there  is  tenseness,  and  our  treatment  seems  to 
be  very  much  alike,  how  do  we  know  that  the  same  treatment  will  cause 
an  opposite  effect? 

A.  That,  is  a  good  question.  There  is  a  certain  lesion,  in  one  case 
there  is  an  approximation,  in  the  other  a  separation;  there  would  be  no 
trouble  in  diagnosis.  You  must  not  misunderstand  the  use  of  the  terms, 
too  much  or  too  little  life  directed  to  a  point.  That  is  true,  but  there 
may  be  exceptions,  in  case  of  a  sudden  wrench  or  jerking  of  the  ver- 
tebras apart,  which  frequently  happens,  there  would  not  necessarily  ibe 
a  relaxation  of  the  ligaments.  But  that  is  a  general  method  of  reason- 


56  THEORY   OF   OSTEOPATHIC  WORK    UPON   NERVES  AND   CENTERS. 

ing;  I  have  mentioned  it  for  the  sake  of  its  importance.  But  as  to  your 
question  how  we  could  get  the  different  effect  by  practically  the  same 
treatment,  it  simply  amounts  to  this:  that  in  each  case  you  are  trying 
to  stimulate  parts;  in  one  where  there  is  -a  tightening  of  the  ligaments 
you  use  a  stretching  motion  to  draw  them  apart;  in  the  next  case  where 
they  are  separated,  granting  there  is  too  little  life  there,  you  wish  to 
stimulate  them  by  stretching  them,  and  getting  the  benefit  of  the  recoil 
and  throwing  more  life  to  the  part. 


LECTURE  X. 

At  the  last  lecture  I  brought  out  the  point  that  from  the  preceding 
arguments,  it  became  apparent  that  the  whole  field  of  nerve  force  wa? 
open  to  the  Osteopath,  and  that  the  probability  was  that  there  was  no 
nerve  in  the  body  which  he  could  not  affect  either  directly  or  indirectly, 
thus  opening  to  him  the  whole  field  of  nerve  life.  That  the  question  of 
degree  of  stimulation  was  not  an  important  one,  since  the  Osteopath 
manifestly  could  stimulate  or  inhibit,  that  is,  could  affect  the  nerve  in 
such  a  way  as  to  gain  the  desired  end.  I  then  quoted  certain  texts  from 
Kirk  concerning  an  experiment  upon  a  rabbit's  ear,  section  of  the  nerve 
followed  by  vaso-dilatation  of  the  ear,  he  showing  that  the  same  thing 
could  be  done  by  pressure  of  the  thumb  nail  upon  the  nerve;  also  a 
quotation  from  Greene  concerning  the  reflex  process  being  generally 
due  to  stimulation,  which  might  be  applied  mechanically.  The  general 
idea  of  those  quotations  being  to  show  that  we  could  from  the  books 
get  authority  for  what  we  have  been  arguing;  that  that  did  not  limit  us, 
since  we  have  shown  that  we  can  get  results  in  every  part  of  the  body ; 
hence,  we  are  not  limited  to  the  same  kind  of  experiments  as  the  physi- 
ologist when  he  gains  results  by  external  experimentation,  but  since  we 
can  reach  the  whole  body,  we  are  privileged  to  say  that  we  can  stimu- 
late the  nerves  in  any  part  of  the  body.  To-day  we  continue  the  same 
subject. 

I.  THEORY  OF  OSTEOPATHIC  WORK  UPON  CENTERS. 
—  (Continued.) — The  subject  grows  under  my  pen,  and  I  do  not  know 
but  there  will  be  several  more  lectures  before  we  shall  have  concluded 
the  subject.  I  have  been  calling  your  attention  to  the  fact  that  the  view 
I  gave  you  of  mere  stimulation  or  inhibition,  direct  or  indirect,  was  not 
the  important  thing  that  the  Osteopath  considers  when  working  upon 
nerve  centers.  I  have  reserved  that  until  now,  calling  it  the  second  view 
taken  by  the  Osteopath  in  regard  to  stimulation  or  inhibition  of  nerve 
action.  This  is  that  by  the  removal  of  lesion,  some  obstruction  which 


THEORY   OF   OSTEOPATHIC   WORK    UPON    NERVES   AND   CENTERS.  0  i 

has  been  preventing  the  direct  flow  of  the  blood  or  nerve  force,  the 
tendency  toward  the  normal  is  left  free  to  act.  That  is  the  kernel  of  our 
work,  I  believe.  Not  that  we  do  not  do  the  other  things,  but  I  wish 
to  lay  stress  upon  the  fact  you  must  look  for  lesions,  and  having  found 
the  lesion  and  having  removed  it,  you  do  not  have  to  stop  to  consider 
whether  it  is  stimulation  or  inhibition  that  you  must  produce.  After 
you  have  the  lesion  removed  you  have  the  ever  present  tendency  toward 
the  normal  to  regulate  the  activity,  and  leave  Nature  to  do  the  work. 
In  case  the  lesion  or  obstruction  had  been  such  as  to  inhibit  nerve  action 
or  lessen  the  conductivity  of  the  nerves,  and  thus  prevent  the  proper 
conduction  of  nerve  impulses,  and  you  remove  that  lesion,  the  result 
would  practically  be  stimulation.  For  instance,  you  might  have  had 
the  tightening  of  the  spine  along  the  region  of  the  upper  splanchnics 
resulting  in  an  impingement  upon  the  branches  connecting  with  the  sym- 
pathetics  in  that  region,  thus  interfering  with  the  nerve  force  to  the 
solar  plexus  and  to  the  stomach.  The  result  might  be  a  case  of  dyspep- 
sia. There  you  have  an  inhibition  of  nerve  force;  you  have  not  enough 
life  to  digest  the  food  put  into  the  stomach.  When  you  have  removed 
that  obstruction,  what  have  you  done?  You  have  taken  away  that  ob- 
struction, you  have  left  Nature  free  to  act,  and  she  will  go  about  stimu- 
lating and  renewing  the  nerve  force  at  that  point.  What  you  did  was 
to  correct  the  lesion,  you  did%not  stimulate  nor  inhibit,  you  did  not  care 
about  that  particular  point  in  your  treatment.  On  the  other  hand,  if 
the  lesion  has  been  just  sufficient  to  bring  irritation  upon  the  nerve  and 
to  keep  it  stimulated  to  an  abnormal  degree  of  activity,  that  is  'what 
you  would  call  abnormal  stimulation  of  the  nerve,  then  by  removal 
of  the  lesion,  you  would  obtain  the  result  of  inhibition.  That  is,  you 
would  remove  the  irritation,  leaving  free  the  tendency  toward  the  normal 
to  act,  and  the  result  of  Nature's  work  would  be  a  quieting  of  the  nerve. 
and  thus  a  cure.  You  have  simply  corrected  the  lesion.  A  very  familiar 
example  of  such  a  condition  is  seen  in  female  troubles;  you  may  have  a 
uterine  tumor  affecting  the  hypogastric  plexus,  irritating  the  kidneys. 
If  that  tumor  is  taken  down  or  removed  the  result  would  be  inhibition, 
but  you  have  simply  corrected  the  lesion.  This  is  the  most  important 
thing  that  the  operator  dees;  he  removes  lesions  in  the  great  majority 
of  cases.  The  lesion  may  Ibe  lack  of  nutrition;  that  is.  of  blood-supply 
to  the  nerve;  it  may  be  a  displacement  of  some  important  part,  bringing 
direct  pressure  upon  the  nerve.  No  matter  what  the  lesion  be,  the 
Osteopath's  knowledge  of  anatomy,  and  his  trained  sense  of  touch  en- 
able him  to  discover  abnormalities  in  anatomy  and  gives  him  his  peculiar 
adaptability  for  the  treatment  of  disease.  I  do  not  know  that  it  is  because 
we  are  any  wiser  than  physicians,  because  I  do  not  think  we  are,  but 
it  is  because  our  system  differs  from  others  radically.  We  look  at  disease 


58  THEORY    OF    OSTEOPATHIC    WORK    UPON    NERVES    AND    CENTERS. 

from  an  entirely  different  standpoint.  I  hope  later  to  take  up  that  sub- 
ject, the  different  systems  and  schools  of  medicine  and  their  modus 
operandi.  The  result  of  our  method  is  that  we  make  a  correct  diagnosis 
of  the  case.  You  remember  that  Dr.  Hildreth  put  especial  emphasis 
upon  that,  stating  that  the  strong  point  of  Osteopathy  is  that  we  make 
a  correct  diagnosis,  that  we  diagnose  from  a  physical  standpoint.  In 
many  cases  the  Osteopath  diagnoses  and  removes  some  displacement, 
hence  the  importance  of  looking  for  the  lesion  in  every  case.  To  illus- 
trate the  difference  between  the  position  taken  by  our  medical  friends 
and  our  position;  when  I  was  visiting  at  my  home  about  a  year  ago, 
a  young  man  called  on  me  to  be  examined.  It  was  the  same  old  story 
of  a  dislocated  hip,  the  leg  being  shorter  than  it  ought  to  be  tby  about 
an  inch,  and  there  being  a  tumor  upon  the  side  of  the  sacrum,  made 
of  course  by  the  protrusion  of  the  head  of  the  femur.  Now,  he  told  me 
how  the  doctor  had  examined  him,  simply  by  settting  him  on  the  other 
side  of  the  room  and  questioning  him.  That  illustrates  the  difference 
in  our  methods.  You  will  find  that  in  your  practice,  there  will  not  be 
a  month  pass  but  that  <you  will  find  some  similar  case  where  the  doctor 
has  simply  sat  across  the  room  and1  questioned  the  patient,  and  has  not 
made  a  thorough  physical  diagnosis.  So  if  you  will  take  the  trouble 
arid  will  thoroughly  acquaint  yourself  with  texts  on  physical  diagnosis, 
I  think  you  will  be  amply  repaid. 

By  quoting  from  the  operators  in  the  building  I  wish  to  show  that 
they  believe  that  we  reach  centers  and  affect  nerve  force  directly  by  the 
removal  of  lesions.  I  quote  first  from  Dr.  Hildreth;  "In  the  first  place, 
where  a  lesion  may  exist,  by  manipulation  or  rather  by  Osteopathic 
treatment,  you  reduce  the  lesion,  you  re-establish  a  natural  circulation, 
and  in  so  doing  you  carry  away  any  obstruction  which  may  exist.  You 
thus  remove  the  obstruction  to  nerve  centers.  If  there  be  a  contracted 
condition  of  muscles,  the  dislocation  of  vertebrae,  or  recent  injury  of 
tissues,  sometimes  without  dislocations,  all  these  conditions  may  pro- 
duce disease  of  the  different  nerve  centers  of  the  spine,  and  the  effect 
of  Osteopathic  treatment  in  all  these  conditions  is  to  help  to  re-establish 
a  natural  nerve  current,  thereby  restoring  a  normal  condition  of  circula- 
tion, thus  relieving  all  tensions  on  nerve  centers.  With  this  done  thor- 
oughly health  cannot  help  but  follow,  for  a  healthy  condition  is  a  natural 
condition." 

Thus  you  see  that  Dr.  Hildreth's  idea  is  that  the  Osteopath  adjusts 
abnormalities  existing  in  the  anatomy  and  leaves  Nature  free  to  restore 
a  condition  of  health.  I  wish  to  adc1  this  to  what  Dr.  Hildreth  has  said; 
in  some  few  cases  you  will  find  that  all  that  is  necessary  to  do  is  to 
stimulate  the  blood  supply.  The  blood  supply  acting  through  a  longer 
pr  shorter  time  removes  the  lesion.  What  you  have  done  in  that  case 


THEORY   OP    OSTEOPATHIC   WORK    UPON    NERVES   AND    CENTERS.  59 

was  not  to  remove  the  lesion,  but  you  have  stimulated  the  blood  supply, 
which  you  have  done  thiough  direct  manipulation  of  the  nerves  con- 
trolling circulation.  In  that  case  the  matter  is  reversed,  the  cart  before 
the  horse.  You  have  to  do  this  in  the  case  of  rheumatism,  where  there 
are  deposits  in  articulations.  That,  of  course,  is  not  a  primary  lesson, 
but  it  is  a  lesion.  You  must  stimulate  the  blood  flow  so  that  it  will 
absorb  those  deposits.  We  sometimes  absorb  small  abscesses,  or  thick- 
ening of  parts  in  that  way.  You  first  remove  the  primary  lesion,  and 
then  the  secondary  result  has  been  to  remove  the  other  lesion.  Of 
course  we  cannot  always  bring  facts  down  to  fit  theories. 

I  quote  further  from  Dr.  McConnell;  "Our  Osteopathic  work  is 
largely  performed  in  correcting  lesions  involving  nerves  or  nerve  centers, 
also  in  correction  of  the  lesions  of  the  arterial,  venous,  lymphatic,  and 
other  fluids  that  bear  a  relation  to  such  centers.  In  some  few  cases  we 
simply  correct  lesions  of  nerves  passing  from  or  to  the  brain,  or  the 
cord,  or  sympathetic  chain,  or  to  the  organ  affected."  You  see  that  Dr. 
McConnell's  idea  is  that  we  work  upon  nerve  centers,  but  that  we  do 
it  by  affecting  either  the  fluids  of  life  or  the  nerve  forces  of  life.  His 
idea  being  that  we  remove  lesions,  as  his  words  imply.  He  also  says 
that  we  sometimes  work  to  restore  organic  activity  or  health  by  remov- 
ing a  lesion  from  a  nerve,  that  is,  independent  of  its  center.  That  is, 
you  may  have  a  pressure  upon  a  nerve,  and  removal  of  that  lesion  may 
not  affect  the  center.  From  Dr.  Turner  Hulett  I  quote  as  follows; 
"Pressure  upon  a  nerve  fiber  would  cause  a  break  in  the  continuity  of 
the  semi-fluid  axis  cylinder  and  the  damming  back  of  its  current  upon 
its  center  of  supply.  If  any  abnormality  exists,  then  the  ever  present 
tendency  toward  the  normal  will  tend  to  restore  normal  ^conditions. 
If  the  previous  condition  was  abnormal  stimulation,  then  inhibition  or 
desensitization  was  accomplished;  if  it  was  sub-normal,  then  stimulation 
was  accomplished."  This  expresses  very  nicely  what  I  have  tried  to 
show  you,  that  whether  you  stimulate  or  inhibit  depends  upon  the 
nature  of  the  lesion  that  you  remove.  I  might  quote  further  from  other 
operators,  but  lack  of  space  forbids.  I  hope  this  subject  is  not  growing 
threadbare.  We  hear  a  great  deal  about  removal  of  lesions  and  stimu- 
lations, etc.,  and  perhaps  you  get  a  little  tired  of  it,  but  I  think  it  im- 
portant to  get  these  things  correlated  in  some  definite  system  of  argu- 
ment, so  that  we  may  have  together  the  points  relative  to  Osteopathy. 

We  have  thus  answered  two  or  three  questions  propounded.  First, 
what  does  the  Osteopath  mean  when  he  says  he  "stimulates  or  inhibits?" 
Second,  how  does  he  affect  internal  life  by  manipulation  upon  the  out- 
side of  the  body?  and  we  have  partly  answered  the  third,  How  does  he 
affect  centers?  I  have  taken  this  up  in  detail  because  these  questions 
are  some  of  the  most  bothersome  to  the  young  Osteopath,  and  to  the 


60        THEORY  OF  OSTEOPATHIC  WORK  UPON  NERVE  CENTERS. 

older  ones  as  well  sometimes,  and  if  you  are  prepared  with  arguments, 
you  may  retain  many  a  patient  by  explaining  these  things  to  him  in  a 
logical  way. 

Now,  as  to  how  we  work  upon  centers,  I  wish  to  carry  the  argu- 
ment a  little  further.  From  what  I  have  quoted  from  Doctors  Hildreth. 
Hulett  and  McConnell,  you  see  that  they  believe  that  we  work  upon 
centers;  first,  by  the  removal  of  lesions  or  obstructions,  and,  second,  by 
direct  stimulation;  and  there  is  no  doubt  that  we  do  affect  centers. 
What  I  have  quoted  from  them  was  given  to  me  in  reply  to  the  question, 
"How  do  you  affect  centers  in  the  spine?"  I  wish  to  call  your  atten- 
tion to  the  fact  that  the  conclusion  is  inevitable  from  what  has  been  said 
that  we  must  reach  NERVE  CENTERS,  not  simply  nerves  alone.  Certain  facts 
which  we  show  bear  out  this  conclusion.  Speaking  of  the  sympathy 
between  the  area  that  is  supplied  by  the  fifth  nerve  and  the  area  which 
is  supplied  by  the  vagus  nerve.  Dr.  Jacobson,  Dr.  Hilton's  editor,  says: 
"This  sympathy  is  an  example  of  a  reflected  sensation  in  which  the  con- 
nection between  the  nerves  concerned  takes  place  in  the  nervous  center." 
Thus  you  have  your  effect  running  up  one  nerve,  through  a  brain  cen- 
ter, and  down  another  nerve.  Now,  if  you  have  a  lesion  affecting  the 
periphery  of  one  of  these  nerves,  and  you  remove  that  lesion,  you  have 
naturally  affected  the  center  in  the  brain;  there  is  no  doubt  whatever 
of  that.  He  gives  a  case  of  obstinate  vomiting  in  a  child,  which  was 
cured  by  simply  removing  from  each  ear  of  the  child  a  bean  which  had 
been  introduced  in  play.  There  was  a  stimulation  of  the  fifth  nerve; 
the  impulse  must  have  gone  through  the  floor  of  the  fourth  ventricle, 
out  over  the  vagus  to  the  stomach.  Of  course  there  is  a  connection 
of  the  fifth_  nerve  and  vagus  by  means  of  the  sympathetic,  but  it  is 
indirect,  and  it  is  probable  that  the  brain  center  was  the  connecting 
link,  as  Dr.  Jacobson  says.  Removing  the  bean  reacted  upon  the  con- 
nected nerve  through  this  center. 

Again,  we  must  reach  nerve  centers  by  the  very  definition  of  reflex 
action,  which  we  know  is  an  action  caused  by  an  impulse  sent  back 
along  a  nerve  to  a  center  and  then  out.  From  its  very  definition,  if  we 
cause  reflex  action  by  manipulation,  the  inference  is  inevitable  that  we 
affect  centers.  That  we  may  do  this  is  shown  in  performing  the  experi- 
ment for  the  tendon  reflex.  This  is  very  easily  done  by  crossing  the  leg 
at  about  right  angles  and  then  getting  the  reflex  by  tapping  the  tendon. 
That  is  a  reflex  action.  You  have  sent  the  impulse  from  the  nerve 
endings  in  the  muscle  back  to  the  center  in  the  cord  which  governs  the 
nerve  supply  of  the  muscles  of  the  limb;  the  gluteal  muscles  have  con- 
tracted and  thrown  the  limb  up.  So  you  have  affected  the  center. 
Again,  every  time  we  set  up  a  vaso-motor  action  we  have  probably 
acted  upon  a  center.  Howell's  Text  Book  says  that  the  vaso-motor  nerves 


TREATMENT   OF   THE   SPINE.  61 

can  be  excited  reflexly  by  afferent  impulses  conveyed  either  from  the 
blood  vessels  themselves,  or  from  end-organs  of  sensory  nerves  in  gen- 
eral. The  thing  is  proven  the  moment  you  show  that  vaso-motor 
actions  are  reflex  actions.  1  have  instanced  here  the  bleeding  of  the 
nose,  epistaxis,  stopped  by  irritating  the  superior  cervical  ganglion  of  the 
sympathetic;  simple  stimulation  of  the  neck  at  that  point  has  stopped 
bleeding  of  the  nose.  The  conclusion  is  that  you  have  acted  through  a 
nerve  center. 

I  have  shown  FIRST,  that  we  affect  a  nerve  and  its  area  of  distribu- 
tion directly,  instancing  the  result  of  pressure  of  the  ulnar  nerve  where 
it  crosses  the  "crazy  bone"  so-called,  thus  you  have  numbness  in  the 
hand ;  you  have  affected  that  nerve  in  its  area  of  distribution  directly,  not 
through  a  center.  SECOND,  we  affect  a  center  by  removal  of  a  lesion,  the 
beans  in  the  ear  being  the  example  cited.  And  THIRD,  we  affect  a  center 
without  removal  of  lesion,  but  by  the  effect  upon  the  nerve,  as  in  the  ear 
of  the  rabbit,  there  was  no  lesion  removed  when  we  press  on  the  nerve, 
we  acted  on  the  nerve  back  through  the  center  and  got  our  effect.  Those 
are  at  least  three  different  ways  in  which  we  may  affect  nerve  action. 

II.  HOW  TO  TREAT  A  SPINE.— (Continued.)—  I  have  examined 
this  gentleman  and  find  the  curves  of  his  spine  are  not  normal.  What 
I  wish  to  do  is  to  work  inward  this  curve  in  the  lumbar  region,  and  to 
make  more  pronounced  this  curve  in  the  upper  dorsal  region,  because 
it  is  flattened,  while  the  other  is  drawn  out  a  little  posteriorly;  thus  you 
have  a  somewhat  straight  spine.  At  the  risk  of  being  tiresome,  I  bring 
these  points  up  in  detail  as  I  took  them  up  in  examination  of  the  spine. 
I  think  you  know  what  to  do  here  as  well  as  I.  I  have  shewn  you  how 
to  approximate  or  separate  vertebrae,  and  you  would  treat  by  a  combina- 
tion of  the  methods  I  have  shown  you;  the  relaxation  treatment  with 
the  patient  on  his  face,  or  springing  of  the  spine  all  along;  the  relaxa- 
tion of  the  ligaments  and  muscles,  and  thus  of  the  blood  and  nerve  froce 
to  those  parts.  By  a  combination  of  these  treatments  you  would  tend 
to  strengthen  the  normal  curves.  You  would  thus  remove  the  lesion, 
which  would  be  the  tightening  or  tension  that  had  thrown  them 
out  of  their  normal  curves,  and  would  leave  nature  free  to  act.  You 
cannot  quickly  replace  those  vertebras  in  their  normal  curves ;  you  must 
strengthen  gradually  and  build  up  the  spine  in  order  that  it  may  take 
its  normal  position.  This  tendency  toward  the  normal  is  of  great  use 
to  the  Osteopath. 

You  may  find  the  COCCYX  in  almost  any  position,  either  anterior  or  to 
one  side.  What  you  must  do  is  to  give  a  local  treatment.  The  method 
of  digital  treatment  is  to  first  place  the  figer  along  the  curve  of  the 
coccyx,  and  by  working  from  side  to  side  to  free  all  the  ligaments  and 
tissues  thereabout.  In  this  way  you  loosen  everything  over  the  foramina 


62  TREATMENT  OF  THE   SPINE. 

where  the  nerves  emerge,  or  any  binding  down  which  may  have  occurred 
over  the  nerves  directly.  You  have  inserted  the  finger  and  have  turned 
it  so  that  you  have  worked  every  side;  you  must  thoroughly  relax  be- 
fore attempting  to  reset.  This  must  be  done  not  only  internally,  but 
you  must  thoroughly  relax  all  the  muscles  externally.  It  will  take  some 
time,  but  you  can  at  each  time  you  treat  the  patient  bend  the  coccyx 
toward  its  proper  position.  Of  course  there  are  lesions  of  the  coccyx 
which  may  be  set  immediately.  In  general,  it  is  recent  dislocations  that 
yield  thus  quickly  to  treatment.  When  it  is  chronic,  as  it  usually  is,  you 
will  have  to  go  slowly.  Suppose  the  coccyx  was  tending  to  be  slightly 
curled,  as  is  frequently  the  case,  you  must  spring  it  backward  each  time. 
You  must  go  according  to  the  conditions,  and  must  constantly  spring 
the  spine  toward  its  proper  position.  I  explained  the  troubles  which 
may  follow  this  displacement,  and  I  do  not  need  to  take  them  up  now. 

The  SACRUM  may  be  anterior  or  posterior.  I  shall  consider  that  more 
in  detail  when  we  come  to  the  consideration  of  the  pelvis  itself.  But, 
supposing  it  was  posterior,  we  would  at  first  loosen  all  the  tissues, 
muscles  and  ligaments,  and  then  adopt  the  method  I  showed  the  other 
day — get  your  knee  before  the  bulging  portion  and  spring  it  inward, 
a  direct  application  of  the  treatment  to  the  displaced  part.  It  is  a  good 
deal  like  putting  a  coccyx  back  into  place,  by  training  it  in  the  way 
it  should  go.  Now  you  may  also  get  the  same  motion  that  I  showed 
you  and  spring  the  sacro-iliac  articulation  in  this  way.  Then  have  the 
patient  lie  on  his  back,  and  you  can  get  a  very  good  motion  for  the 
sacrum  in  this  way;  your  hand  is  placed  in  this  position,  the  knuckles 
forming  one  fulcrum  and  the  tips  of  the  fingers  the  other;  there  are 
two  fixed  points;  you  have  the  ends  of  the  fingers  placed  against  the 
sacro-iliac  articulation,  and  your  knuckles  against  the  table.  You  thus 
have  two  fixed  points,  and  you  can  in  this  way  relax,  by  an  upward, 
downward  and  outward  motion  of  the  limb,  all  the  muscles  and  liga- 
ments. The  weight  of  the  pelvis  is  upon  those  two  fixed  points;  it  gives 
a  considerable  spring,  and  is  a  very  good  motion.  In  case  the  sacrum 
is  anterior,  of  course  it  is  very  hard  to  apply  any  direct  treatment  to  it, 
but  use  the  motion  I  have  just  shown  you;  stimulate  and  relax  every 
part,  and  depend  on  the  tendency  toward  the  normal.  You  might,  by 
getting  pressure  upon  the  side  of  the  pelvis,  spring  down,  but  I  doubt 
if  you  could  do  much  in  that  way.  Your  tendency,  however,  would  be 
to  approximate  the  innominates  and  to  cause  it  to  bulge  out. 


THEORY   OF   OSTEOPATHIC   WORK    UPON   NERVES   AND    CENTERS.  03 

LECTURE  XI. 

At  the  last  lecture  I  continued  the  consideration  of  the  theory  of 
Osteopathic  work  on  centers,  calling  to  your  attention  the  second  view 
taken  by  the  Osteopath  as  to  how  we  stimulate  or  inhibit  nerve  action, 
the  idea  being  that  as  a  rule  we  remove  some  lesion,  and  that  that  is 
our  strong  point  in  diagnosis — to  find  some  lesion  which  we  may  reduce 
to  the  normal,  and  thus,  if  the  tendency  before  was  toward  stimulation. 
you  have  removed  the  lesion  and  allowed  nature  to  tend  toward  inhibi- 
tion, and  vice  versa.  You  do  not  have  to  split  hairs  over  the  question 
as  to  whether  you  employ  a  certain  motion  to  stimulate  and  a  certain 
other  motion  to  inhibit.  That  is,  as  far  as  lesion  goes,  you  have  re- 
moved the  lesion.  I  quoted  from  different  ones  of  the  operators  to  show 
that  that  was  the  view  generally  held.  I  also  called  your  attention  to 
the  fact  that  sometimes  you  stimulate  blood  supply  to  remove  the.  lesion, 
which,  although  secondary,  is  still  a  lesion;  as,  for  instance,  we  stimulate 
the  blood  and  nerve  force  to  remove  deposits  in  rheumatism,  and  to 
cause  absorption  of  abscesses,  and  things  of  that  kind.  I  had  answered 
two  questions  propounded  and  partly  the  third,  as  to  the  effect  we  have 
upon  nerve  centers.  Then  I  went  further  into  the  question  of  how  we 
might  affect  centers,  bringing  to  your  attention  the  fact  that  the  quota- 
tions I  made  from  the  operators  were  given  in  response  to  that  question, 
and  one  way  was  by  the  removal  of  lesions.  Another  way  was  that  in 
any  manipulation  of  the  nerve  we  must  very  likely  affect  centers,  as,  for 
instance,  in  getting  a  reflex  effect,  because  from  the  definition  of  reflex 
action  we  must  have  affected  the  center,  and  we  often  produce  reflex 
action  by  work  upon  a  nerve,  not  a  center.  I  instanced  a  case  of  ob- 
stinate vomiting  produced  by  the  irritation  of  beans  in  the  ears.  The 
fact  that  you  have  removed  the  vomiting  shows  that  you  reached  the 
center;  that  you  worked  through  a  brain  center;  up  one  nerve  and  down 
another  nerve  to  the  periphery,  to  the  organ  supplied  by  the  nerve.  The 
fact  also  that  we  can  produce  vaso-motor  action  shows  that  we  have 
affected  centers,  since  vaso-motor  actions  are  essentially  reflex.  Thus 
I  showed  that  we  may  affect  a  nerve  by  three  ways:  ist.  we  may  directly 
affect  it  and  its  area  of  distribution  by  direct  work;  2d,  we  may  affect 
the  center  by  removal  of  lesion  to  the  nerve;  3d,  we  may  affect  a  center 
without  removal  of  lesion,  as  when  we  produce  a  reflex  action.  To-day 
I  continue  the  same  subject. 

I.  THEORY  OF  OSTEOPATHIC  WORK  UPON  NERVE 
CENTERS. —  (Continued.') — In  the  December  issue  of  the  Journal  of 
Osteopathy,  a  theory  was  given  in  an  article  by  Dr.  Lawrence  M.  Hart, 
one  of  our  recent  graduates,  which  I  think  was  worthy  of  notice.  It 
was  well  received  at  the  time  I  believe,  and  I  have  thought  that  it  con,' 


64  THEORY   OF    OSTEOPATHIC   WORK    UPON    NERVES   AND    CENTERS. 

tained  points  which  would  be  worthy  of  our  consideration  this  afternoon. 
His  idea  is  that  we  always  remove  lesions.  His  theory,  in  brief,  is  this: 
That  contractures  of  muscles  occur  along  the  spine.  These  contractures 
along  the  spine,  he  says,  act  in  a  way  to  mechanically  shut  off  the  blood 
supply  in  the  branches  supplying  the  spinal  muscles  themselves,  collater- 
ally producing  a  hyperemia  in  the  blood  vessels  running  to  the  cord, 
and  in  that  way  stimulating  the  nerves,  irritating  them,  and  thus  leading 
to  inhibition,  the  final  result  always  being  an  inhibition,  and  the  lesion 
always  being  contracture.  There  are  certain  points  with  which  I  do 
not  agree.  I  will  call  those  up  later,  but  I  will  go  over  the  reasoning 
that  he  has  followed,  bringing  out  his  points.  In  the  first  place,  he 
says  there  are  two  ways  in  which  *a  nerve  may  be  affected  through  its 
blood  supply,  and  that  is  true.  In  the  first  place,  you  may  have  anemia 
of  the  nerve;  that  is,  lack  of  blood  supply,  robbing  it  of  its  nutrition  and 
leading  finally  to  a  degenerated  nerve,  and  paralysis  of  the  part  supplied 
follows.  In  the  second  place,  you  may  have  hyperemia  of  the  nerve, 
which  he  claims  leads  to  an  irritation,  there  being  too  much  blood 
thrown  to  the  part,  leading  to  abnormal  activity;  this  leads  to  too  much 
stimulation,  resulting  in  inhibition.  In  one  case  from  aremia  and  de- 
generation you  have  paralysis;  in  the  other  case  you  have  practically  the 
same,  an  inhibition  which  is  likely  to  be  more  temporary,  because  it  is 
produced  by  ah  over-supply  of  blood  and  not  by  starvation.  Thus  you 
see  that  his  argument  leads  always  to  the  one  result  of  inhibition.  He 
calls  our  attention  to  the  distribution  of  the  blood  supply  to  the  spinal 
cord,  showing  how  the  branches  from  the  vertebral,  intercostal,  lumbar 
and  other  arteries  in  their  respective  regions  run  to  supply  both  the 
cord  and  the  spinal  muscles,  the  same  branch  supplying  both;  that  is, 
dividing  to  supply  both,  the  posterior  division  running  to  the  spinal 
muscles,  and  the  other  division  running  to  the  cord  and  its  membranes. 
He  shows  the  close  relation  between  the  blood  supply,  and  states  the 
fact  that  from  the  occiput  to  the  coccyx  all  of  the  muscles  and  parts  of 
the  cord  are  thus  supplied.  Now,  his  argument  is  that  in  contracture  of 
muscles,  the  lumen  of  the  vessels  being  thus  practically  closed,  the  over- 
supply  of  blood  is  sent  through  the  branch  which  supplies  the  mem- 
branes of  the  cord,  thus  producing  a  condition  of  hyperemia  about  the 
cord.  In  the  first  place,  this  would  result  in  throwing  too  much  blood 
supply  to  the  nerves  in  question  and  the  nerve  centers  of  the  cord;  the 
result  would  be  that  by  over-blood  supply  there  would  be  over-stimula- 
tion, leading  finally  and  naturally  to  an  inhibition  of  nerve  force,  and 
thus  you  see  there  would  always  be  inhibition.  Now,  in  relieving  this 
condition,  we  of  course  take  away  the  lesioii;  we,  by  our  methods,  relax 
these  old  contractures,  and  allow  a  return  of  the  flow  of  blood  through 
them,  and  thus  take  away  the  overplus  which  is  being  misdirected  to  the 


THEORY  OF  OSTEOPATHIC  WORK  UPON  NERVES  AND  CENTERS      65 

cord  and,  through  the  centers,  affecting  other  parts  of  the  body.  You 
see  that  the  point  is  made  that  we  remove  lesions  and  that  is  one  reason 
why  I  bring  this  up.  Whatever  the  result,  according  to  his  theory,  if 
I  correctly  understand  it,  we  have  always  stimulated;  but  since  we 
remove  lesions  and  then  leave  nature  to  work,  it  is  not  an  essential 
question  to  us  whether  we  stimulate  or  inhibit,  which  is  another  good 
point,  because  there  has  been  a  good  deal  of  hair-splitting  as  to  whether 
you  should  give  a  certain  twist  to  stimulate,  or  a  certain  other  twist  to 
inhibit.  Now,  to  me,  Dr.  Hart's  theory  is  valuable  in  bringing  promi- 
nently to  your  attention  this  one  kind  of  lesion,  contracted  muscle,  and 
showing  the  probable  effect  produced.  This  is  at  least  one  kind  of 
lesion  with  which  we  have  to  deal.  He  shows  the  importance  which  we 
must  attach  to  this  condition  of  contracted  muscle,  which  we  frequently 
find  along  the  spine.  I  doubt  if  there  will  be  a  day  in  your  practice 
in  which  you  will  not  find  such  a  condition  along  the  spine.  In  the 
criticisms  I  have  to  make,  I  do  so  not  to  criticise  the  article,  but 
simply  for  the  purpose  of  bringing  out  the  points  which  I  think  will 
be  helpful  to  you.  From  his  article  I  do  not  gather  that  he  allows  of 
other  lesions,  though  perhaps  I  am  mistaken.  I  do  not  think  he  makes 
it  general  enough.  Now,  there  are  a  great  many  other  lesions  along  the 
spine  which  will  affect  nerve-centers  and  nerve-distribution,  and  saying 
that  contracture  is  the  only  cause  of  lesion  is  far  from  correct.  So  that 
his  theory  is  true  only  when  the  lesion  is  in  the  nature  of  a  contracture; 
and  then  I  do  not  agree  with  the  explanation,  but  I  shall  speak  of  that 
later. 

I  wish  to  call  your  attention  further  to  the  fact  that  we  sometimes 
stimulate  and  sometimes  inhibit.  After  you  have  removed  the  lesion, 
you. sometimes  have  to  do  your  Osteopathic  work  upon  parts  affected, 
and  in  those  cases  you  must  stimulate  or  inhibit.  In  the  case  of  head- 
ache we  frequently  have  to  hold  and,  as  we  call  it,  inhibit  centers  in  the 
neck,  while  in  the  case  of  epistaxis  we  would  stimulate  the  superior 
cervical  ganglion.  Then,  again,  to  remove  the  chalky  deposits  in  rheu- 
matism, or  in  absorbing  an  abscess,  we  have  to  stimulate  frequently,  and 
in  that  case,  of  course,  it  is  not  a  matter  of  removal  of  lesions.  Now,  I 
have  said  that  I  think  the  explanation  of  the  effects  following  contracture 
is  only  partly  true,  and  for  this  reason:  I  believe  the  theroy  is  some- 
what too  mechanical,  making  this  a  mechanical  shutting  down  upon 
blood  supply,  and  thus  sending  an  overplus  to  other  parts.  The  theory 
does  not,  according  to  my  mind,  take  into  consideration  enough  the 
mechanism  of  nerve-distribution  to  the  vessels  and  to  the  muscles  of  the 
back.  Hence,  I  have  gone  somewhat  further,  and  have  endeavored  to 
explain  the  conditions  which  would  follow  contractures  on  the  theory 
of  nerve  influence.  I  believe  that  the  generally  accepted  view  is  that 


66  THEORY   OF    OSTEOPATHIC   WORK   UPON    NERVES   AND   CENTERS. 

not  only  the  blood  vessels  of  the  body,  but  all  the  functions  of  life, 
are  directly  under  control  of  the  nervous  system,  sympathetic  or  cerebro- 
spinal.  I  think  it  would  be  more  in  line  with  the  accepted  theroy  if 
we  could  explain  these  things  according  to  some  theory  of  nervous 
influence  which  they  have  produced.  Now,  it  is  reasonable  to  suppose 
that  there  is  by  contracture  some  vaso-motor  influenece  set  up.  Me- 
chanical contraction  would  result  in  overplus  of  blood  to  the  cord  and 
its  meninges  through  the  collateral  branches.  That  would  be  inevitable, 
but  that  condition  would  hardly  be  permanent  unless  the  vessels  were 
dilated  to  accommodate  it,  so  that  we  must  look  for  some  sort  of  a 
nervous  action  to  account  for  the  blood  remaining  at  that  place;  other- 
wise the  blood  would  be  distributed  about  the  body,  and  the  collateral 
equalization  would  be  set  up,  and,  as  you  had  anemia  along  the  spinal 
muscles,  you  would  have  that  much  more  blood  in  other  parts  of  the 
body,  not  necessarily  just  along  the  spine;  that  is,  in  case  the  mechanical 
theory  holds  true.  But  I  believe  you  might  have  in  such  case  not  only 
hyperemia  of  the  cord,  but  you  might  have  anemia  of  the  cord  and  its 
centers.  If  the  muscles  contracted  and  shut  off  the  blood  supply  me- 
chanically only,  you  cannot  have  a.  rthing  but  hyperemia;  but  if  our 
theory  according  to  nervous  mechanism  is  correct,  you  can  have  either. 
There  is  no  question  that  contractures  are  important  lesions.  For  in- 
stance, we  have  heart  troubles  caused  by  lesions  along  the  back.  I  re- 
member having  heard  Dr.  Hildreth  say  that  in  case  of  weakness,  general 
debility,  and  irregular  heart  action,  he  always  looks  on  the  left  side  be- 
tween the  shoulders  for  some  contracture  of  muscles  in  that  part,  and 
that  such  a  condition  would  usually  make  the  patient  despondent.  Dr. 
Hildreth  also  said  that  when  he  found  such  a  lesion  on  the  right  side 
of  the  spine  it  usually  had  the  opposite  effect.  Such  is  Dr.  Hildreth's 
explanation  of  this  kind  of  lesion  along  the  spine,  and  there  must  be 
some  good  explanation  for  the  results  thus  prdouced.  Now,  to  me  it 
seems  very  probable  that  the  contractures  act  not  so  much  mechanically 
as  through  vaso-motor  centers  and  fibres  which  they  involve,  and  not 
only  that,  but  indirectly  through  the  nervous  mechanism  of  the  muscles 
involved.  I  quote  from  Gowers  on  the  Nervous  System:  "The  sensory 
nerves  of  muscles  have  been  shown  by  Tschirjew  to  commence  not  in 
the  muscular  fibres  but  in  the  interstitial  connective  tissue."  Then  he 
goes  on  to  explain  his  theory  of  why  we  get  a  "myostatic  reflex"  action, 
the  term  he  has  adopted  for  "tendon  reflex."  He  says  that  in  such  a 
case  the  muscle  is  upon  a  tension.  In  showing  you  how  to  produce  the 
knee-reflex,  I  crossed  the  knees,  thus  bringing  tension  on  the  muscles 
above  the  knee;  then  if  you  shock  the  muscle,  not  necessarily  the  tendon 
itself,  you  get  the  throwing  out  of  the  foot.  He  bases  his  theory  on  the 
sensory  nerve-endings  between  the  muscle  fibres  being  impinged  upon 


THEORY   OF   OSTKOPATHIC   WORK    UPON   NERVES   AND    CENTERS.  67 

by  the  fibres  themselves.  It  seems  reasonable  to  suppose  that  if  the 
muscle  is  in  a  state  of  tonic  contraction  there  would  be  a  pressure 
upon  the  nerves,  and  that  is  a  fair  explanation  of  the  sore  spots  we  find 
along  the  spine.  Those  sore  spots  have  been  started  in  a  contracture. 
It  has  become  axiomatic  that  we  must  look  for  the  sore  spots  along 
the  spine,  and  you  will  find  that  they  coincide  with  the  seat  of  the 
lesion,  which  is  the  contracture.  That  theory  would  account  ior  the 
spot  being  sore,  that  is,  providing  it  had  not  been  of  too  long  standing, 
in  which  case  if  you  find  it  not  sore,  you  might  account  for  it  by  the 
same  theory — that  stimulation  has  gone  on  until  it  is  equal  to  inhibition. 
I  am  a  good  deal  like  Dr.  Hildreth  when  he  says,  "If  this  theory  does 
not  suit  you,  figure  one  out  for  yourself."  While  I  am  endeavoring  to 
explain  these  things  in  as  scientific  a  way  as  possible,  if  my  theories  are 
not  correct,  it  is  your  privilege  to  do  better. 

Now,  not  only  would  we  affect  the  terminal  sensory  fibers  in  the 
muscles,  but  we  know  that  there  is  a  close  connection  between  the  spinal 
nerves  and  the  sympathetics,  and  it  looks  very  probable  that  an  effect 
might  be  sent  from  a  muscle  through  its  sensory  terminal  to  affect 
the  sympathetic  nerves,  and  thus  to  affect  the  general  sympathetic  life, 
irrespective  of  any  effect  you  might  have  through  the  blood-supply  upon 
nerve  centers  in  the  spinal  cord.  Thus  you  get  the  direct  sympathetic 
effect  from  the  irritation  of  sensory  nerves.  I  quoted  from  Howell's 
Text  Book  a  few  days  since  to  show  that  nerves  were  frequently  stimu- 
lated through  their  sensory  terminations  in  the  muscles.  Now,  as  I ' 
have  said,  I  believe  this  contracture,  taking  the  theory  that  it  acts 
tiirough  the  blood-supply,  may  thus  produce  either  vaso-dilation  or 
vaso-contraction,  according  to  the  centers  affected  along  the  spine.  I 
here  quote  from  Kirke;  "The  vaso-dilator  nerves  in  part  accompany 
those  first  described,  but  are  not  limited  to  the  out-flow  from  the  2d 
thoracic  to  the  2d  lumbar."  Further;  "The  vaso-constrictor  nerves 
for  the  whole  body  leave  the  spinal  cord  by  the  anterior  roots  of  the 
spinal  nerves  from  the  2d  thoracic  to  the  2d  lumbar."  My  argument 
is  that  since  you  have  both  vaso-dilator  and  vaso-constrictor  centers 
along  the  spine,  according  to  the  quotation  from  Kirke;  that  acting  on 
the  center  affected  you  might  have  either  a  vaso-dilation  or  vaso-con- 
striction;  you  may  have  anaemia  or  hyperemia  of  the  center  involved. 
That  looks  reasonable  to  me  from  the  theory  of  nervous  mechanism 
of  the  blood-supply.  In  case  the  lesion  were  such  that  it  brought  this 
overflow  of  blood  upon  a  vaso-constrictor  center,  that  center  would  be 
stimulated  at  first,  and  the  first  result  would  be  to  shut  off  the  blood 
to  the  parts  affected  by  the  contraction,  resulting  from  the  over  stimula- 
tion of  that  vaso-constrictor  center.  Thus  you  might  have  anaemia; 
the  constrictor  may  act  in  such  a  way  as  to  entirely  shut  off  the  blood 


68  THEORY   OF   OSTEOPATHIC   WORK   UPON   NERVES  AND   CENTERS. 

from  a  part.  Byron  Robinson  is  authority  for  the  statement  that  the 
sympathetics  may  crowd  the  blood  from  a  part  even  unto  death.  How- 
ever, suppose  that  the  action  has  gone  so  far  that  the  stimulation  has 
resulted  first  in  irritation,  then  in  inhibition,  so  that  there  is  a  paralysis 
there,  then  your  constriction  is  lost;  your  dilators  are  not  opposed  and 
there  would  be  a  flooding  of  the  part;  a  hyperemia.  In  line  with  this 
theory  I  quote  what  Green  has  to  say.  He  says  that  hyperemia  of  a 
nerve  center  leads  to,  first,  an  excessive  nervous  excitability,  together 
with  paraesthesia  of  sight  and  hearing,  and  finally  may  even  lead  to  con- 
vulsions. 

On  the  other  hand,  if  in  the  first  place  the  vaso-dilator  center  be 
affected,  you  have  the  dilators  over-stimulated,  resulting  in  hyneremia, 
"but  when  it  went  on,  finally  resulting  in  paralysis  of  those  dilators, 
then  the  unopposed  action  of  the  constrictors  would  set  up  an  anemia, 
and  that  would  be  a  permanent  result.  It  would  lead  to  death  of  the 
part  paralyzed  from  the  excessive  anemia  of  the  spinal  centers  and 
the  spinal  nerves.  Thus  you  get  an  effect  not  only  upon  the  spine, 
but  upon  the  whole  distribution  of  that  nerve.  You  can  see  what  would 
be  the  probable  effect  of  anemia  or  hyperemia  of  the  cord,  either  from 
this  shutting  down  of  the  contractures  upon  the  blood-supply,  according 
to  one  part  of  the  theory,  the  other  part  of  the  theory  being  that  this 
contracture  might  shut  down  directly  upon  the  nerve  and  through  it 
send  the  effect  to  the  part  supplied  by  the  nerve.  Thus  you  see  that 
contractures  along  the  spine  may  act  as  stimulators  or  inhibitors  mechan- 
ically. So  in  this  case  we  remove  the  lesion  for  its  own  sake,  and  not 
simply  to  stimulate. 

So  much  for  that  thought.  I  wish  to  take  up  another  question  in 
relation  to  blood-supply,  how  it  affects  nerve  life,  and  how,  perhaps, 
the  Osteopath  may  thus  influence  nerve-life  through  blood-supply.  That 
is  perhaps  gettting  the  cart  before  the  horse,  according  to  the  previous 
argument,  still  from  the  facts  which  I  wish  to  bring  to  your  attention, 
it  looks  as  though  we  might  accomplish  this.  This  question  is  not 
proven,  but  I  thus  throw  it  out  for  the  sake  of  suggestion.  It  may  lead 
to  a  good  theory  later.  The  quantity  of  natural,  healthy  blood  in  the 
vessels  of  a  part  acts  reflexly  upon  the  mechanism,  that  is,  the  vaso- 
motor  nervous  mechanism,  and  thus  affects  the  parts.  There  would 
thus  be  a  collateral  equalization  of  the  blood  throughout  the  body.  As 
I  stated,  the  facts  that  I  have  to  give  along  this  line  do  not  strictly 
prove  the  point,  and  I  have  not  tried  to  make  them  do  so,  but  they  are 
valuable  as  hints.  In  the  first  place,  if  Dr.  Hart's  argument  be  true 
that  the  effect  of  the  blood  may  be  stimulation  resulting  in  inhibition, 
or  that  it  may  be  inhibition  direct,  then  the  quantity  of  the  blood  in  a 
part,  being  drawn  from  the  spinal  muscles  to  the  centers,  the  mere 


•THEORY  OF  OSTEOPATHIC  WORK  UPON  NERVES  AND  CENTERS.        69 

quantity  of  blood  would  account  for  the  effect  upon  the  nervous  mechan- 
ism. I  use  the  term,  pure,  healthy  blood,  because  I  do  not  take  into 
consideration  the  question  of  the  effect  of  deteriorated  blood,  which 
you  know  is  a  different  thing.  From  Green's  quotation  we  see  that 
he  considers  the  effect  of  hyperemia  upon  nerve  centers  to  be  paresthesia, 
convulsions,  etc.  Howell's  Text-Book  states;  "There  is  in  some  degree 
an  inverse  relation  ^between  the  vessels  of  the  skin  and  of  the  deeper 
structures,  by  the  reflex  mechanism  of  the  vaso-motor  centers."  If 
superficial  parts  have  their  vessels  dilated,  deeper  parts  have  them  con- 
tracted, the  flow  of  blood  being  regulated  in  different  parts  of  the  body 
according  to  conditions.  The  question  is,  what  is  the  stimulation?  There 
was  one  of  our  students  who  conceived  the  idea  that  the  fibres  of  the 
solar  plexus  distributed  upon  the  blood  vessels  close  to 'the  heart, 
chiefly  upon  the  aorta,  were  stimulated  by  the  flow  of  blood  from  the 
heart  into  the  vessels;  that  they  thus  acted  as  vaso-constrictors  or  di- 
lators, and  propelled  the  blood,  producing  the  rythmic  beat  of  the  aorta. 
This  student  wrote  to  Bryon  Robinson,  who  replied  that  lie  considered 
it  a  very  reasonable  theory.  Hence,  you  may  have  the  quantity  of  blood 
thrown  into  the  aorta  acting  as  a  stimulant.  Green  further  notes  the 
fact  that  in  hyperemia  following  inflammation,  in  other  parts  of  the  body 
there  is  collateral  anemia,  because  there  being  too  much  blood  in  one 
place,  there  is  too  little  in  another  place.  As  I  said,  I  quote  these  facts 
as  suggestions,  and  not  for  the  sake  of  proving  the  theory,  but  if  that 
theory  can  be  proven,  it  will  be  important  to  the  Osteopath;  he  may 
mechanically  pump  blood  into  a  part,  as  for  instance  by  flexion  of  the 
thigh;  he  might  repeatedly  flex  it  and  pump  blood  into  it  and  thus  get  a 
vaso-motor  effect  which  is  mechanical.  Thus,  he  may  get  a  nervous 
effect  through  the  quantity  of  blood  sent  to  the  part.  We  sometimes 
make  a  practical  application  of  such  a  theory  by  working  upon  the 
splanchnics  to  reduce  the  amount  of  blood  in  the  head;  the  parts  gov- 
erned by  the  splanchnics  being  a  sort  of  a  reservoir  for  an  over-plus  of 
blood,  and  we  send  it  from  one  part  to  another. 

II.  HOW  TO  TREAT  A  SPINE.— (Continued.)— As  to  the  second 
part  of  my  lecture,  I  shall  try  to  conclude  this  subject  if  possible.  There 
is  one  point  I  want  to  give  you  in  relation  to  the  general  treatment  of 
the  spine.  When  you  have  acute  hyperesthesia,  an  acute  tenderness 
all  along  the  spine,  Doctor  Still  treats  in  the  neck,  in  the  cervical  en- 
largement, ^corresponding  to  the  spines  of  the  cervical  vertebras,  and  in 
the  lumbar  enlargement  of  the  cord  corresponding  to  the  spines  of  the 
last  three  or  four  dorsal  and  the  space  between  the  I2th  dorsal  and 
ist  lumbar. 

There  is  one  treatment  that  I  have  not  shown  you.  It  is  a  treatment 
in  which  the  operator  simply  brings  his  weight  to  bear  in  this  way;  He 


70  TREATMENT  OP  THE    SPINE. 

kneels  upon  the  table,  one  knee  upon  either  side  of  the  patient,  who  is 
lying  on  his  face,  and  presses  downward  with  thumbs  or  palms.  That 
is  what  I  have  denominated  the  "straddling  treatment." 

I  mentioned  to  you  that  we  frequently  get  sounds  along  the  spine 
which  are  due  to  motion  between  parts,  and  in  some  cases  that  that  was 
due  to  a  slipping  of  the  ribs  to  their  place,  and  when  I  have  worked 
along  the  spine  by  gettting  direct  pressure  over  one  side  only,  and  have 
not  been  able  to  produce  these  noises  with  their  accompanying  result, 
it  was  probably  because  I  did  not  get  equal  pressure  upon  both  sides, 
but  when  I  adopted  this  "straddling  movement"  it  brought  equal  pres- 
sure on  both  sides,  then  I  could  get  that  sound  and  the  good  effect  fol- 
lowing the  replacement  of  the  parts  in  that  way. 

I  might  call  your  attention  to  the  technique  of  stretching  some  of 
these  SCAPULAR  MUSCLES.  You  will,  in  your  treatment  of  the  upper  part 
of  the  spine,  either  to  reduce  contractures,  or  to  loosen  the  muscles 
along  the  spine,  find  that  you  must  stretch  these  scapular  muscles.  It 
is  a  good  plan  to  push  the  patient's  arm  well  down  to  the  side  on  a  level 
with  the  table,  then,  putting  the  hand  beneath  the  scapula  until  the 
fingers  are  over-lapping  the  spinal  edge  of  the  scapula  (the  shoulder 
blade  has  been  approximated  to  the  spine),  there  is  not  much  space 
between  the  spine  and  the  edge  of  the  scapula.  By  holding  the  muscles 
firmly  against  the  edge  of  the  scapula  you  can  stretch  so  that  by  bring- 
ing the  arm  across  the  chest  you  bring  a  tension  upon  the  scapular  mus- 
cles. By  the  use  of  the  thumb  on  the  scaleni  muscles  at  the  side  of  the 
neck,  bringing  the  arm  up  over  the  head,  with  your  thumb  over  those 
muscles  you  can  loosen  them,  this  being  a  prepartory  step  to  the  set- 
ting of  the  first  and  second  ribs.  You  must  have  those  muscles  relaxed, 
and  you  get  the  effect  in  this  way  as  well.  Just  hold  them  with  one  hand 
while  you  push  the  elbow  up  toward  the  head  and  around  toward  the 
body.  Those  are  motions  frequently  employed  in  practice. 

There  is  a  question  now  as  to  how  to  reach  the  PSOAS  MUSCLE.  It  is 
one  of  the  flexor  muscles  of  the  thigh.  It  is  a  good  plan  to  straighten 
the  legs  out  and  then  bow  the  back  forward  at  the  lumbar  region;  that 
gives  it  some  little  stretch  and  effects  the  psoas  muscle.  The  lumbar 
plexus  is  formed  in  the  substance  of  the  psoas  muscle,  and  if  it  is  con- 
tracted you  may  have  trouble  with  that  plexus. 

I  want  to  show  you  one  other  motion  which  it  is  sometimes  neces- 
sary to  use,  though  with  great  moderation.  I  show  it  to  you  princi- 
pally to  warn  you  against  its  use.  The  patient  lies  on  his  face  and  you 
lift  the  legs  from  the  table  and  then  work  from  side  to  side;  you  can 
thus  stretch  the  psoas  muscle  often  more  than  you  did  before,  and  by 
working  upward  along  the  spine,  one  operator  placing  his  hand  on  one 
side  of  the  vertebrae,  the  other  on  the  other,  you  can  thus  bring  pressure 


THEORY   OF   OST^OPATHIC    WORK    UPON    NERVES   AND    CENTERS.  71 

against  either  side  of  the  vertebrae.  This  is  the  treatment  called 
"BREAKING  UP  THE  SPINE."  It  is  frequently  used  with  very  good  effect  in 
cases  of  diarrhoea,  flux  and  other  troubles.  The  warning  is  that  you 
should  not  raise  the  knees  high  above  the  talble;  if  }'ou  do  that  and  bow 
the  back  too  much  you  may  have  serious  results,  and  Doctor  Still  has 
cautioned  us  against  any  such  performance,  so  you  must  be  extremely 
careful,  though  the 'motion  is  useful  in  reaching  certain  troubles.  You 
might  not  only  strain  the  spine  and  the  anterior  ligaments,  but  you 
might  tip  the  parts  of  the  pelvis.  Dr.  McConnell  spoke  of  a  case  which 
had  been  injured  in  that  way,  and  which  has  been  serious  ever  since;  he 
said  he  had  found  that  the  innominate  bones  had  been  slipped,  and  that 
there  was  an  inequality  at  the  symphysis  of  the  pubes. 


LECTURE  XII. 

I  wish  to  recapitulate  a  little  in  regard  to  the  eleventh  lecture.  At 
that  time  I  brought  up  the  theory  of  work  upon  a  spine  through  the 
effect  we  could  get  by  removing  lesions  in  the  shape  of  contracture  of 
muscles.  I  referred  to  Dr.  Hart's  theory,  his  idea  being  that  con- 
tractures  of  muscles  shut  off  the  blood  supply  in  the  muscular  branches 
of  the  arteries,  and  the  overplus  is  thus  thrown  to  the  cord  and  affects 
centers  and  nerves,  stimulating  at  first,  but  afterwards  leading  to  inhibi- 
tion. I  explained  how  his  view  led  up  to  that  result.  I  then  went 
further  and  endeavored  to  show  that  such  a  process  must  necessarily  be 
by  affecting  vaso-motor  nerves,  otherwise  the  blood  would  not  be  retained 
about  the  centers  of  the  cord  to  influence  them.  And  further,  that  we 
might  have  an  effect  not  merely  upon  the  vaso-motor  nerves  and  their 
centers,  but  we  might  have  an  effect  directly  through  the  terminal  sen- 
sory branches,  running  from  the  muscles,  upon  sympathetic  and  internal 
life.  I  then  brought  merely  to  your  notice,  without  attempting  to  prove 
it,  the  point  that  possibly  the  amount  of  blood  in  a  part  would  account 
for  certain  nervous  effects.  Then,  again,  the  theory  of  Byron  Robinson, 
that  the  pumping  of  the  blood  from  the  heart  into  the  aorta  may  set  up 
a  reflex  action.  And  finally  the  quotation  from  Green's  Pathology  that 
there  was  always  a  reflex  relation  of  the  circulation,  that  if  the  super- 
ficial vessels  were  dilated,  the  deep  vessels  were  contracted,  and  vice 
versa;  and  from  these  and  other  facts  it  seemed  probable  that  we,  by 
working  mechanically,  as  for  instance  pumping  blood  into  the  limb, 
bringing  a  certain  quantity  of  blood  to  act.  upon  nerves,  could  influence 
nerves  and  centers. 


72  THEORY   OF    OSTEOPATHIC    WORK    UPON   NERVES   AND    CENTERS. 

I.  THEORY  OF  OSTEOPATHIC  WORK  UPON  NERVE 
CENTERS. —  (Continued.} — I  wish  to  continue  the  same  general  subject 
to-day,  going  a  little  further  into  the  question  of  CONTRACTURES  ;  THEIR 
OCCURRENCE,  NATURE  AND  CAUSE.  Now,  as  to  the  occurrence  of  con- 
tractures  along  the  spine  and  in  other  parts  of  the  body,  their  impor- 
tance, I  think,  was  fully  brought  out  in  the  last  lecture,  in  showing 
you  how  important  they  become  when  considered  as  lesions  along  the 
spine,  especially  from  an  Osteopathic  standpoint.  We,  as  Osteopaths,  find 
a  great  deal  to  say  about  contracted  muscles,  and  we  are  backed  by  the 
authorities  when  we  are  talking  about  them.  When  we  tell  a  patient  that 
there  is  a  muscle  in  his  back  or  neck  which  has  become  contracted  and 
failed  to  relax,  he  is  sometimes  inclined  not  to  believe  it,  because  the 
popular  idea  is  that  a  muscle  contracts  and  relaxes  when  you  wish  it  to, 
and  that  it  cannot  contract  and  hold  on.  You  will  also  find  that  when 
you  get  out  among  the  medical  fraternity  they  will  try  to  pick  flaws  in 
your  argument,  and  unless  you  are  backed  up  by  authority,  you  hardly 
feel  so  strong  in  argument  as  you  otherwise  would.  Hence,  I  have  taken 
up  this  question  a  little  further  to  show  that  what  are  termed  "contrac- 
tures"  are  recognized  by  the  different  authorities.  Howell's  Text  Book 
says,  "A  contracture  is  a  state  of  continued  contraction  of  a  muscle." 
Gowers  on  the  Nervous  System  says,  "Tonic  spasm,  persistent  and  involv- 
ing only  a  certain  group  of  muscles,  causes  distortion  of  the  parts  to 
which  they  are  attached,  and  is  termed  a  contracture."  In  the  Journal 
article  which  I  quoted  at  the  last  lecture  a  quotation  is  made  from  Dr. 
Allen's  work  on  Human  Anatomy,  which  is  as  follows :  "An  abnormal 
phase  of  tonicity  is  met  with  when  a  muscle  sustains  unduly  prolonged 
action  of  its  fibers;  under  these  circumstances  a  shortening  of  its  belly 
takes  place,  which  persists  as  long  as  the  cause  of  the  contraction  is  main- 
tained. Such  abnormal  modification  of  contraction  is  termed  contracture. 
Stretching  of  a  contractured  muscle  is  readily  accomplished  and  main- 
tained, provided  the  cause  for  the  contracture  is  removed.  Contracture, 
clinically  considered,  is  a  subject  of  great  importance.  In  lateral  curvature 
of  the  spine  contracture  of  muscles  will  take  place  on  the  side  of  least 
curvature."  Hence,  you  see  that  the  authorities  agree ;  they  say  that  con- 
tractures  are  of  considerable  clinical  importance :  they  say  that  they  cause 
distortion  of  parts  to  which  they  are  attached.  Others  besides  Osteopaths 
attach  significance  to  this  congested  condition  of  the  muscle  which  we  call 
contracture. 

But  it  is  important,  perhaps,  in  taking  up  this  subject,  to  show  that 
the  Osteopath,  in  work  upon  contractures,  in  treating  them  as  lesions,  and 
in  removing  them,  is  thoroughly  scientific  and  has  the  weight  of  authority 
and  science  behind  him.  There  is  a  question  as  to  what  the  nature  of  a 
contracture  is.  We  saw  from  the  quotation  above  that  Gowers  understood 


THEORY  OP  OSTEOPATHIC  WORK  UPON  NERVES  AND  CENTERS.          73 

it  to  be  tonic  spasms ;  then  Howell's  Text  Book  says  that  continuous  con- 
tractions may  be  caused  by  continuous  excitation,  and  it  regards  it  as  a 
tetanus.  Such  a  condition  may  be  found  also  in  involuntary  muscles 
When  you  are  in  practice  y6u  will  find  that  frequently  in  your  work 
upon  the  intestines  they  are  drawn  and  hardened,  and  this  is  an  abnormal 
tonicity  which  is  regarded  in  the  same  light  as  contractures.  although  that 
term  is  not  applied  to  it.  You  will  recognize  by  touch  the  normal  feeling 
of  the  abdomen,  and  hence  will  be  able  to  recognize  any  departure  from 
'the  normal.  Kirk  is  authority  for  the  following  statement:  "Though 
involuntary  muscle  cannot  be  thrown  into  tetanus,  it  has  the  property  of 
entering  into  a  condition  of  sustained  contraction,  called  tonus,"  which 
is,  as  far  as  our  purpose  goes,  practically  the  same  thing.  You  will  find 
in  your  work  that  there  is  quite  a  difference  between  the  feeling  that  you 
get  from  contracted  muscles  in  the  back  and  the  feeling  that  you  get  when 
working  upon  the  abdomen.  Now,  the  external  muscles  of  the  abdominal 
wall  may  be  contracted  as  well  as  those  internal  muscles,  and  you  will  find 
often  the  outer  covering  of  the  abdomen  much  contracted  and  hardened. 
As  I  said,  you  will  have  to  learn  by  experience  what  is  the  natural  feeling 
of  the  muscles  in  the  back  and  muscles  in  the  abdomen,  and  how  they  have 
departed  from  that  by  becoming  contracted.  Then,  again,  the  question 
comes,  "Is  it  not  exercise  that  makes  these  muscles  hard,  particularly  in 
the  back?  Therefore,  how  can  the  Osteopath  recognize  the  difference 
between  the  normal  hardening  -of  a  muscle  due  to  exercise,  and  a  contrac- 
tion of  the  muscle  which  is  called  a  contracture?"  There  are  various  ways, 
some  of  which  I  shall  give  you  later  in  the  lecture,  but  one  way  is  that 
when  a  muscle  is  hardened  by  proper  exercise  it  is  homogeneously  harden- 
ed, the  same  degree  of  hardness  all  over  it ;  while  when  you  come  to  feel 
of  a  muscle  which  is  contractured,  you  find  it  raised  in  welts.  We  shall 
find  the  reason  for  that  presently.  Of  course,  there  is  contracture  which, 
according  to  the  definition,  would  be  called  contracture.  but  different  from 
what  I  have  been  describing.  That  is  in  set  limbs  in  rheumatism,  and 
things  of  that  kind,  but  you  will  recognize  those  readily  by  the  case  itself. 

Now,  we  usually  find  these  contracted  muscles  not  only  in  the  back 
and  abdomen,  but  we  find  them  frequently  in  the  neck,  and  that  is  one 
important  place  that  you  will  have  to  watch  for  hardening  of  muscles.  The 
explanation  of  the  contracted  muscle  rising  in  welts  on  the  back;  when  you 
work  upon  the  back  you  will  find  that  parts  of  muscle  slip  under  your 
fingers,  as  if  you  were  working  over  a  whip  cord  or  something  hard  ;  that 
is  what  is  called  a  welt.  You  will,  of  course,  find  muscles  normally  con- 
tracted to  produce  motion.  I  take  the  following  quotation  from  Cowers, 
which  will  explain  itself:  ''Every  movement  is  due  to  a  contraction  of 
a  series  of  fibres,  which  seldom  corresponds  to  the  series  massed  together 
in  a  muscle."  That  is,  you  frequently  have  a  contraction  of  different  fibres, 


74  THEORY  OF   CENTERS.      CONTRACT0RES. 

you  might  say  a  sort  of  a  wave  of  contraction  running  through  different 
fibres  of  different  muscles  to  produce  complex  movement,  and  he  says  that 
it  is  seldom  that  these  movements  are  massed  together  in  a  muscle.  Of 
course,  there  are  prominent  exceptions  to  the  rule,  one  being  that  of  the 
biceps.  He  goes  on  to  say,  "Fibres,  not  muscles,  are  represented  in  the 
structure  of  the  brain,  and  those  that  cause  a  simple  movement  may  be 
in  several  muscles."  Hence,  a  derangement  of  a  certain  part  of  the  motor 
area  in  the  cerebrum  may  cause  a  lesion  of  parts  of  several  muscles,  or 
a  lesion  of  different  motor  nerve  fibred  may  cause  a  contraction  of  parts 
of  different  muscles.  Howell's  Text  Book  states,  "If  the  muscle  be  in  an 
abnormal  state  the  contraction  may  remain  localized  as  a  swelling  or  welt." 
That  is  the  term  by  which  we  usually  describe  those  contractions. 

The  Osteopath  is  sure  of  his  grounds  Scientifically  when  he  says  to  a 
patient  that  the  muscle  has  contracted  and  has  failed  to  relax.  When  he 
finds  that  such  a  condition  is  present,  it  is  a  basis  of  work  on  his  part,  to 
be  treated  as  a  lesion,  and  when  he  describes  it  as  a  welt,  he  is  in  accord 
with  the  authorities. 

The  question  naturally  comes;  "What  is  the  CAUSE  OF  THESE  CON- 
TRACTURES?"  The  Osteopath  regards  them  as  peculiarly  significant  from 
his  standpoint.  We  noted,  in  quoting  from  Howell's  Text  Book,  that  he 
said  constant  irritation  produced  constant  contraction,  so  it  must  be  some 
irritation  which  is  continually  acting  upon  the  muscle  itself  or  upon  its 
nerve  connection,  causing  it  to  act  in  this  way.  That  would  lead  you  to 
inquire  if  the  irritation  came  through  the  sympathetics.  You  will  find 
some  of  the  visceral  diseases  sending  continuous  impulses  over  the  sympa- 
thetics, through  the  spinal  nerves  to  the  muscles  of  the  back.  Dr.  Allen, 
in  the  article  quoted  from  the  Journal,  states;  "Contracture  of  muscle,  is 
due  to  disease  of  the  muscles,  to  primary  disease  of  the  nervous  system, 
to  loss  of  antagonism,  as  well  as  to  excessive  use  of  one  set  of  muscles 
over  another."  Cowers,  in" speaking  of  nerves  and  muscles,  says;  "The 
excitability  is  changed  by  disease,  of  which  the  change  is  often  an  im- 
portant symptom.  It  indicates  the  state  of  nutrition  of  the  nerve-fibres 
and  muscles,  and  from  this  we  can  draw  important  inferences  regarding 
the  condition  of  the  centers."  Cowers  states  that  paralysis  or  abnormal 
excitability  of  a  nerve  refers  to  the  nerve  center  controlling  it.  If  the 
abnormal  excitability  has  been  such  as  to  result  in  contraction,  it  will  refer 
us  to  the  point  from  which  the  irritation  came ;  it  may  be  the  distant  center 
or  distant  periphery  of  some  other  set  of  nerves,  reflected  sympathetically. 

In  discussing  before  you  previously  the  Osteopathic  view  of  contracted 
muscles,  I  said  that  the  Osteopath  regarded  them  in  one  case  as  primary 
and  in  another  case  as  secondary.  Primary  is  where  a  muscle  is  directly 
acted  upon  by  some  external  force,  some  blow,  strain,  or  draught  of  cold 
air,  causing  it  to  contract.  The  contraction  then  is  your  primary  lesion. 


THEORY   OF   CENTERS.      CONTRACTURES.  75 

It  will  impinge  upon  the  nerve  fibres,  as  we  saw  a  few  days  ago  in  quota- 
tions from  one  of  the  authorities,  that  the  terminal  sensory  fibres  of  the 
muscles  are  irritated  by  contractures,  and  that  constant  irritation  may  be 
set  up  and  carried  into  the  system  anywhere,  according  to  the  centers 
affected.  This,  then,  would  be  a  primary  lesion.  A  secondary  lesion  would 
be  one  of  the  kind  described  a  few  minutes  since,  when  I  noted  the  fact 
that  we  might  have  stomach  trouble  producing  secondarily  a  lesion  of  the 
muscle  of  the  back  producing  welts,  so-called  contractures.  When  the 
lesion  is  primary,  it  indicates  at  once  to  us  where  the  trouble  is.  and  you, 
as  Osteopaths,  have  learned  by  this  time  that  you  must  go  to  the  seat  of  the 
trouble;  even  though  you  have  to  trace  it  a  long  way  back,  you  will  finally 
come  to  it.  So  that  when  you  have  the  contracture  acting  as  a  primary 
cause  of  disease"  from  its  nervous  connections,  then  of  course  by  removing 
the  contracture,  you  have  removed  that  which  is  irritating  or  inhibiting. 
You  have  restored  the  normal,  and  allowed  Nature  to  take  care  of  the 
balance.  When  it  is  secondary,  it  is  a  symptom,  as  Gowers  says,  of  a 
diseased  condition  of  a  center ;  'it  may  be.  and  so  the  Osteopath  treats  it. 
In  case  the  diseased  stomach  has  caused  a  contracture  in  the  back,  we 
could  not  say  that  bv  removing  that  lesion  that  we  have  removed  the 
primary  cause.  But  the  value  of  that  to  the  Osteopath  is  that  he  thereby 
sees  where  the  trouble  is ;  it  is  to  him  a  symptom,  and  he  can  trace  it  back, 
and  aided  by  other  symptoms,  find  the  original  cause.  Not  only  that,  but, 
according  to  what  we  have  learned  previously,  the  effect  that  the  Osteo- 
path can  have  by  working  through  nerve  terminals  may  be  gotten.  He 
can  work  upon  these  lesions,  which  are  secondary,  and  remove  them,  and 
thus  affect  the  peripheral  terminations.  Now,  if  the  cause  works  back- 
ward over  these  nerves,  his  work  can  reach  forward  along  the  same  track. 
and  he  can  get  an  effect  upon  the  original  seat  of  the  disease.  He  can 
stimulate  the  stomach,  in  other  words,  by  working  along  the  back  in  the 
region  of  the  splanchnics.  Of  course  he  would  combine  work  upon  the 
secondary  lesion  with  work  ur-on  the  orieinal  cause  of  the  disease,  what- 
ever it  was,  and  his  good  judgment  and  ability  to  diagnose  would  have  to 
tell  him  when  the  lesion  was  primary  or  secondary.  I  recollect  a  case  of 
Chorea  which  had  been  of  seven  years'  standing.  It  was  the  case  of  a 
voune  lady  who  was  some  twenty  years  of  age,  an'!  was  very  bad  when 
brought  to  us.  She  tossed  about  and  nearly  threw  herself  from  the  table, 
and  it  reauired  one  to  hold  while  another  treated.  The  lesion  in  that  case 
we  found  along  the  back  on  the  left  side  of  the  spine:  the  muscles  were  in 
a  contracted  condition  all  along  that  side  of  the  spine.  We  also  found  that 
the  mticcles  in  the  neck  were  quite  stiff.  We  were  particular  to  remove 
that  congested  condition  of  the  muscles,  and  the  cure  was  comolete.  al- 
though the  case  had  been  of  so  long  standing.  It  was  a  satisfactory  case. 
Now,  the  question  is,  whether  that  was  a  primary  lesion  or  a  secondary, 


76  LANDMARKS   CONCERNING  THE  NECK. 

and  it  is  very  hard  to  say.  The  causes  of  Chorea  are  external  sometimes ; 
rheumatism  or  exposure,  and  in  such  a  case  the  lesion  may  have  been 
primary,  the  effect  of  exposure  or  rheumatism  may  have  hardened  the 
muscles  in  the  back.  In  other  cases  it  is  due  to  over-work,  worry  and  a 
whole  list  of  different  causes.  So  it  may  have  acted  indirectly,  and  thus 
have  produced  these  contractures  through  the  nervous  system.  By  working 
there  we  remove  that  lesion,  whether  it  was  primary  or  secondary,  and 
we  get  our  results.  We  used  general  treatment  with  the  special  treatment 
which  we  gave  to  the  lesions.  My  chief  purpose  in  following  this  line  of 
thought  was  to  show  that  the  Osteopath  in  talking  about  contractures,  in 
treating  them  as  lesions,  and  in  working  directly  upon  them  as  such,  is 
thoroughly  scientific.  As  I  showed  you  in  previous  lectures,  he  can  work 
upon  nerve  terminals  in  these  muscles  and  thus  gain  important  results. 
And  I  think  that  an  Osteopath  in  an  argument  with  a  physician  ought  not 
to  come  out  second  best. 

There  is  one  further  point  which  I  want  to  bring  out;  that  is  the  fact 
that  you  will  find  FLABBY  MUSCLES,  and  when  a  muscle  has  become  flabby 
it  is  usually  an  indication  that  the  disease  has  progressed  to  a  considerable 
degree.  Very  frequently  these  muscles  have  lost  their  tone,  and  our  mode 
of  reasoning  is  that  we  must  restore  life  to  them.  I  wish  to  state  what 
Gowefs  has  said  in  this  regard.  He  says  that  when  a  muscle  is  thus 
flabby,  it  shows  some  lesion  of  the  nerve-fibers  controlling  the  muscle. 
Pathology  has  shown  that  section  of  a  motor  nerve  of  a  muscle  will  lead 
to  deterioration  in  the  condition  of  the  muscle.  Hence,  there  is  close 
trophic  connection  between  the  nerves  and  the  muscle  fibers,  so  that, 
reasoning  from  that,  when  you  find  a  flabby  condition  of  a  muscle,  you 
must  have  a  diseased  condition  which  has  advanced  considerably. 

In  previous  lectures  I  have  considered  fully  the  spine.  First,  how 
to  examine  it ;  second,  how  to  consider  the  lesions  found,  that  is,  their 
significance ;  and  third,  how  to  treat  your  lesion's  when  found.  I  know 
of  no  other  points  which  I  should  bring  up  in  that  connection.  I  shall, 
therefore,  go  to  the  neck,  and  tell  you  of  its  indications. 

II.  LANDMARKS  CONCERNING  THE  NECK.— First,  as  Holden 
says,  we  note  a  great  difference  between  the  skin  on  the  back  of  the  neck, 
where  it  is  very  thick,  and  that  on  the  front  of  the  neck,  which  is  ex- 
tremely thin ;  this  is  the  best  place  in  the  body  to  note  that  difference. 
The  external  jugular  vein  corresponds  with  a  line  drawn  from  the  angle 
of  the  inferior  maxillary  bone  to  a  point  at  the  middle  of  the  clavical.  We 
find  in  certain  heart  troubles  a  venous  pulse  can  be  detected  in  that  vein, 
we  can  see  it  from  a  distance.  There  is  a  case  in  town  in  which  the 
venous  pulse  can  be  seen  in  the  jugular  vein.  There  is  also  a  venous  hum 
in  that  vein -in  anemia. 


BXAMINATION    OF   THE   NECK.  77 

The  hyoid  bone  is  on  a  level  with  the  lower  jaw;  the  gap  just  below 
it  corresponds  to  the  apex  of  the  epiglottis ;  therefore  any  deep  cut  at 
that  point  leaves  almost  the  whole  of  the  glottis  above  the  cut.  The 
thyroid  cartilage  is  familiar  to  you  all,  and  you  can  by  feeling  carefully 
trace  out  both  the  upper  and  lower  cornua.  The  lateral  lobes  of  the 
thyroid  gland  lie  on  each  side  of  the  thyroid  cartilage;  the  bridge  lies 
across  the  middle,  and  in  that  region  you  can  feel  the  pulsation  of  the 
superior  thyroid  artery.  The  crico-thyroid  membrane,  as  you  know,  joins 
the  thyroid  and  cricoid  cartilages,  and  that  is  the  point  at  which  laryn- 
gotomy  is  performed.  The  level  of  the  cricoid  cartilage  corresponds  to 
the  interval  between  the  fifth  and  sixth  cervical  vertebrae ;  it  is  also  the 
level  of  the  oesophagus.  Hence,  if  a  child  has  attempted  to  swallow  some- 
thing too  large  for  it,  it  will  probably  be  lodged  in  that  place.  The  superior 
opening  of  the  oesophagus  is  usually  arr  inch  and  a  half  above  the  sternum, 
but  it  may  get  as  far  as  two  and  a  fourth  inches  above  the  sternum.  Nor- 
mally about  seven  or  eight  rings  of  the  trachea  protrude  above  the  sternum, 
but  they  are  not  felt  from  the  outside,  being  covered  by  other  structures. 
Surgical  operations  are  conducted  in  the  middle  line  of  the  neck,  which  is 
called  the  "line  of  safety." 

III.  HOW  TO  EXAMINE  THE  NECK:— You  all  know  that  there 
is  nothing  of  greater  importance  to  the  Osteopath  in  the  body  than  the 
neck.  Dr.  Harry  Still  is  authority  for  the  statement  that  almost  all  dis- 
eases of  the  body  can  be  treated  through  the  neck.  This  is  putting  it  very 
broadly,  but  it  is  very  expressive.  You  can  treat  in  the  neck  alone  and 
affect  the  stomach,  heart,  liver  or  intestines  and  you  can  treat  in  the  neck 
and  affect  the  brain,  or  the  vaso-motor  life  for  the  whole  body. 

In  the  examination  of  the  neck  I  have  divided  the  subject  into  first,  the 
THROAT.  You  all  know  where  to  find  the  tonsil,  just  beneath  the  angle 
of  the  inferior  maxillary  bone.  It  is  very  readily  felt  when  you  want  to 
find  it.  In  case  of  tonsilitis  it  is  easily  found.  If  you  cannot  find  it  on 
the  outside,  you  can  examine  inside  the  throat.  So  in  examination  of  the 
throat  you  must  always  look  for  the  tonsils  if  you  suspicion  tonsilitis. 
You  must  look  for  tender  points  about  the  throat,  and  where  we  frequently 
find  them  is,"  in  case  of  catarrh,  just  below  the  angle  of  the  jaw.  Further, 
in  examination  of  the  throat,  always  look  to  see  what  is  the  condition  of 
the  hyoid  muscles.  They  are  of  great  importance  to  the  Osteopath — those 
above  the  hyoid  bone  and  those  below  it ;  either  or  both  may  be  contracted, 
congested,  or  drawn,  shutting  off  the  blood  supply  to  the  other  parts  of  the 
head  or  the  throat,  causing  numerous  troubles.  You  must  always  examine 
your  patient  to  see  that  all  parts  are  normal.  You  should  direct  your  at- 
tention first  to  the  hyoid  bone,  then  to  the  thyroid  and  cricoid  cartilages, 
not  because  we  find  them  of  great  Osteopathic  significance,  but  to  see  that 


78  THEORY   OF    CENTERS.      CERTAIN   LESIONS. 

everything  is  normal.  In  order  to  recognize  the  abnormal  you  must  ac- 
quaint yourselves  with  the  normal.  The  thyroid  gland  itself  has  been 
described.  You  should  bear  in  mind  that  it  may  be  enlarged  in  disease, 
as  in  goitre,  or  it  may  be  atrophied,  as  in  myxedema.  You  will  be  able 
to  find  it  very  readily,  and  you  must  decide  whether  it  is  enlarged  or 
wasted,  and  therefore,  you  must  know  what  is  its  normal  size. 

You  will  frequently  find  that  the  lymphatics  are  enlarged  in  the  neck; 
the  kernels  or  glands  are  found  along  the  course  of  the  veins  in  the  neck; 
The  lymphatic  glands  sometimes  become  enlarged,  and  remain  so  for 
years,  showing  that  there  is  some  irritation  or  some  septic  process  still 
going  on.  In  people  with  chronic  sore  throats  we  will  frequently  find  that 
the  lymphatic  glands  are  enlarged,  sometimes  they  are  left  so  by  diph- 
theria, or  any  disease  which  leaves  in  the  system  a  septic  product,  which 
is  taken  uo  by  the  lymphatics.  So  you  must  look  to  see  whether  or  not 
the  lymphatics  are  enlarged.  If  they  are,  the  treatment  is  not  to  them, 
but  is  to  remove  the  cause  of  the  disease. 

A  further  point  as  to  the  anatomy  of  the  neck  in  connection  with 
Osteopathy;  you  will  find  that  the  glossopharyngeal,  pneumogastric  and 
spinal  accessory  nerves  leave  the  skull  through  the  jugular  foramen.  The 
pneumogastric  runs  on  down  jti«t  behind  the  anterior  border  of  the 
sterno-mastoid  muscle,  and  we  work  upon  it  as  we  work  along  the  muscles. 
Frequently  we  work  upon  it  high  up  at  its  exit  from  the  skull,  that  is,  as 
near  as  we  can  get  to  it.  We  can  usually  bring  deep  pressure  upon  the 
nerves  at  that  point.  Frequently,  also,  we  work  upon  these  nerves  through 
their  sympathetic  connection  with  the  superior  cervical  ganglion. 

The  phrenic  nerve,  as  you  know,  sorings  from  the  3d,  4th  and  5th  cer- 
vical nerves,  and  you  reach  it  at  the  anterior  border  of  the  scaleni  muscles, 
along  in  front  of  the  tranverse  processes  of  the  vertebrae.  You  can  impinge 
upon  the  nerve  by  pressure  between  the  sternal  and  clavicular  origins 
of  the  sterno-mastoid  muscle.  That  is  where  the  treatment  is  usually  given 
in  case  of  hiccoughs. 


LECTURE  XIII. 

At  the  last  lecture,  under  the  general  head  of  theory  of  work  upon 
centers,  I  considered  contractures,  their  occurrence,  nature  and  cause. 
I  explained,  according  to  the  authorities,  how  these  contractures  happened, 
and  that  this  was  the  scientific  definition,  the  term  meaning  continued 
contraction.  I  quoted  from  Cowers,  Howell's  Text  Book,  and  others,  to 
substantiate  the  point.  I  called  to  your  mind  the  clinical  importance  that 
is  attached  to  these  conditions,  especially  by  the  Osteopath.  I  called  to 


THEORY   OF    CENTERS.      CERTAIN    LESIONS.  79 

your  mind  their  nature,  that  is,  that  they  arc  called  a  tonic  spasm,  being 
considered  in  the  nature  of  a  tetanus;  also  the  fact  that  the  continued 
tonicity  of  the  involuntary  muscles  might  exist,  which  for  our  purpose  is 
practically  a  contracture,  although  not  called  so.  I  called  your  attention 
to  how  you  might  recognize  the  difference  between  these  conditions  by  the 
touch.  The  chief  points  where  these  occur  are  in  the  neck,  back  and 
abdomen,  as  well  as  the  limbs"  in  some  cases.  I  called  to  your  attention 
the  fact  that  muscles  normally  contract  not  as  a  whole  usually,  but  as 
separate  fibres  of  several  muscles,  according  to  Gowers'  authority,  and 
that  accounts  for  the  appearance  of  welts,  the  feeling  of  welts  under  the 
fingers.  That  the  cause  was  some  constant  irritation,  some  direct  injury 
to  the  muscle,  or  some  exposure  or  something  of  that  kind.  The  contrac- 
ture might  be  primary,  as  in  the  case  of  a  blow  or  injury;  and  secondary 
wnen  a  muscle  contracts  due  to  a  trouble  which  is  far  removed,  as  for  in- 
stance muscles  over  the  splanchnics  contracted  secondarily  to  the  affection 
in  the  stomach.  I  noted  that  muscles  which  felt  flabby  were  a  sign  that 
the  disease  had  probably  progressed  for  some  time,  and  that  the  centers 
and  nerves  were  affected,  i  also  called  your  attention  to  certain  landmarks 
in  the  neck.  To-day  I  wish  to  consider  the  same  general  subject  further. 

I.  THEORY  OF  OSTEOPATH1C  WORK  UPON  THE  NERVE 
CENTERS. —  (Continued.) — (Under  the  Special  Head  of  Further  Possi- 
ble Lesions.) — 1  have  explained  to  you  the  nature  of  some  lesions;  at  the 
last  meeting  the  nature  of  a  lesion  when  it  is  a  contracture.  I  have  also 
called  to  your  mind  other  lesions,  such  as  a  slip  of  the  vertebrae,  a  dis- 
placement of  a  part,  bringing  pressure  upon  a  blood  vessel  or  upon  a  nerve, 
i  believe  I  mentioned  tumors  at  one  lecture,  but  I  shall  carry  that  idea 
further  at  some  time.  Also  I  mentioned  the  lack  of  normal  blood  supply, 
being  anemia,  or  perhaps  too  much  blood,  being  hyperemia.  So  that  we 
have  already  considered  certain  lesions  which  may  affect  the  body,  may  act 
through  the  nerves  and  cause  disease. 

A  further  very  important  lesion  which  we  frequently  find  in  our  work 
is  a  THICKENING  OF  LIGAMENTS  following  a  strain  or  some  injury.  Path- 
ology teaches  us  that  after  having  irritation  we  frequently  have  an  inflam- 
mation. That  means  that  too  much  blood  is  circulated  about  the  part,  and 
in  the  natural  process  of  inflammation  an  exudation  follows,  first  fluid, 
later  cellular,  of  both  red  and  white  corpuscles.  When  this  state  of  in- 
flammation has  gone  far  enough  you  have  resulting  a  new  growth.  We 
know  that  this  new  growth  is  connective  tissue  or  scar  tissue.  It  will  be 
seen  in  a  disease  called  Cirrhosis  of  the  liver,  usually  induced,  or  some- 
times at  least,  by  the  drinking  of  alcohol.  The  alcoholic  poisoning  sets 
up  an. inflammation.  Following  this  inflammation  there  results  a  growth 
of  new  connective  tissue,  the  connective  tissues  normally  occurring 
throughout  the  liver  are  thickened.  Now,  this  new  growth  of  co/mec- 


80  THEORY  of  CENTERS.    CERTAIN  LESIONS. 

tive  tissue  does  little  harm  as  long  as  it  is  new  and  fresh  and  filled  with 
blood  vessels.  But.  sooner  or  later  the  blood  vessels  begin  to  be  con- 
tracted and  absorbed,  the  tissue  loses  its  blood  supply,  and  then  it  begins 
to  contract  and  become  pale.  When  that  process  has  gone  far  enough, 
the  contraction  has  acted  mechanically  and  shut  down  upon  the  blood 
supply  passing  through  the  liver;  thus  the  portal  circulation  is  obstructed, 
and  the  blood  sets  back  and  produces  what  is  known  as  Ascites,  or 
Dropsy  of  the  Abdomen.  There  you  have  a  thickening  of  the  connec- 
tive tissues,  you  have  resulting  from  that  a  condition  of  pressure,  a  shut- 
ting down  of  the  thickened  tissues  upon  the  parts  concerned.  In  Scler- 
osis of  the  spinal  cord  you  have  a  thickening  of  the  connective  tissue 
either  at  the  expense  of,  or  following  degeneration  of,  the  nervous  ele- 
ments of  the  cord.  When  you  have  had  a  wound,  say  a  cut  with  a  knife, 
you  have,  in  the  process  of  healing,  the  formation  of  what  is  known  as 
granulation  tissues,  this  is  followed  later  by  the  appearance  of  blood  vessels 
in  new  connective  tissue,  and  you  have  your  scar.  So-called  scar  tissues 
occur  not  only  after  cuts  and  wounds,  but  after  abscesses  and  various 
pathological  processes  in  the  body.  I  wish  to  bring  these  things  to  your 
attention  for  the  purpose  of  showing  you  that  it  is  a  constant  and  very 
general  pathological  tendency  in  the  body  to  produce  new  connective 
tissue,  and  it  is  the  tendency  of  that  connective  tissue  when  produced  to 
contract.  There  you  have  something  that  is  a  very  frequent  source  of 
disease,  and  it  is  of  especial  interest  to  the  Osteopath,  from  his  point  of 
view,  since  it  means  that  there  may  thereby  be  a  mechanical  lesion,  a 
direct  shutting  down  upon  the  parts.  You  have  all  known  of  cases 
where  a  scab  has  formed  upon  some  external  sores,  catching  some  sen- 
sory nerve  terminals  in  its  connective  tissue,  as  it  becomes  old  and  com- 
mences to  contract,  it  irritates  those  termination  of  nerves,  producing 
constant  pain  in  the  part. 

I  wish  to  quote  from  Green's  Pathology,  where  he  says ;  "The  new 
connective  tissue  is  called  inflammatory  or  scar  tissue.  The  tendency  to 
contract  is  characteristic  of  this  new  fibrous  tissue.  This  contraction  of 
scar  tissue  may  produce  serious  results."  You  will  readily  recognize  the 
Osteopathic  significance  of  anything  that  will  contract  or  obstruct  the 
channels  of  blood  or  nerve  force.  These  causes  are  especially  significant,  it 
seems  to  me,  in  relation  to  the  spine,  so  I  have  considered  that  first.  Now, 
what  may  the  nature  of  your  lesion  be?  As  I  have  said  before,  it  might  be 
a  VERTEBRA  DISPLACED;  it  may  be  twisted  or  slipped,  or  in  any  way  so  placed 
as  to  bring  irritation  upon  the  parts  surrounding  it.  It  makes  no  prac- 
tical difference  for  our  purpose  whether  first  that  irritation  acts  upon 
nerves  or  upon  blood  vessels,  just  so  it  be  sufficient  to  act  upon  the  liga- 
mentous  parts  about  the  vertebrae  to  irritate  them.  You  will  then  have  an 
inflammation.  Secondary  to  this  irritation  you  may  not  have  inflam- 


»  CENTERS.    CERTAIN  LESIONS.  81 

mation,  ibut  hyperemia.  Following  this  inflammation  you  would  natur- 
ally, according  to  the  laws  of  disease,  have  a  thickening  of  the  connec- 
tive tissue.  I  wish  again  to  quote  from  Green,  speaking  about  inflam- 
mations, and  under  the  head  of  "injuries,  slight  but  long  continued,"  he 
says,  "In  many  cases  the  inflammatory  process  ends  in  the  formation  of 
new  tissue — inflammatory  fibrous  tissue."  You  will  notice  there  that  the 
injury  may  only  be  slight,  but  long  continued.  Such  is  the  nature  of  a 
great  many  lesions  that  we  find  in  the  spine.  A  man  comes  to  the  Osteo- 
path's office  for  examination.  He  says.  "You  have  had  a  strain  or  twist 
here  in  the  spine  in  some  way."  The  patient  says  he  never  had  any  strain 
there.  The  Osteopath  still  thinks  that  he  must  have  had  a  strain  there. 
The  reason  why  he  did1  not  know  it  was  simply  because  it  was  so  slight 
as  to  escape  observation,  and  has  not  been  attended  to  because  slight, 
and  therefore  has  'been  long  continued,  and  finally  results  in  some  process 
of  pathological  growth.  Further,  Green  says,  "If  the  hypertmia  be  of  long 
duration  or  frequently  repeated,  the  epithelium  and  connective  tissue  of 
the  part  increase."  So  an  inflammation  is  not  always  necessary  to  pro- 
duce thickening  of  the  connective  tissue,  but  it  may  occur  from  hyper- 
emia. Too  much  blood  about  a  part  may,  according  to  Green,  cause  a 
thickening  either  of  the  epithelium  or  of  the  connective  tissue.  So  your 
lesion  which  has  produced  netve  irritation  and  caused  inflammation,  may 
be  slight,  or  on  the  other  hand,  may  cause  hyperemia,  which  may  not 
necessarily  be  known  to  the  patient.  So  much,  then,  for  the  tendency 
of  these  newly  formed  tissues  to  contract  and  to  obstruct.  From  what  I 
have  said  you  will  see  the  significance  of  these  things  from  our  stand- 
point, as  I  have  explained  to  ydu  the  effect  of  thickening  of  tendons  or 
hardening  of  muscles  or  ligaments. 

The  lesion  may  be  not  only  in  the  nature  of  some  slip  or  twist  of  the 
vertebrae,  but,  secondly,  it  may  be  a  strain,  a  pull,  a  cold  draft,  or  some- 
thing of  that  nature^EXTERNAL  VIOLENCE.  You  are  all  familiar  with  the 
phenomena  which  follow  a  sprained  ankle,  as  we  call  it,  and  you  have 
probably  often  heard  the  physician  say  that  such  an  injury  was  in  some 
cases  worse  than  a  broken  bone.  You  have,  following  a  strain,  an  inflam- 
matory process,  and  following  that  inflammatory  process,  this  thickening 
of  the  connective  tissue.  Then,  again,  you  may  have  a  lesion  in  the  nature 
of  BAD  BLOOD.  If  the  blood  is  not  pure,  and  if  all  of  the  excretory  organs 
of  the  body  are  not  doing  their  duty,  the  bad  blood  then  acts  as  an  irritant 
and  may  inflame  parts.  Your  lesion  may,  fourthly,  be  in  the  nature  of 
some  EXPOSURE,  or  cold,  or  rheumatism.  Quain,  in  his  dictionary,  speaking 
of  disease  of  the  spine,  says,  "The  ligaments  here,  as  in  other  parts  of 
the  body,  are  especially  liable  to  a  rheumatic  form  of  inflammation." 
Inflammation  means  to  us  the  formation  of  a  new  growth:  a  new  growth 
very  probably  means  the  formation  of  an  obstruction,  which  acts  as  a 


82  THEORY   OF   CENTERS.      CERTAIN   LESIONS. 

continual  irritation  upon  the  part  affected,  with  all  the  concomitant  re- 
sults. In  view  of  the  above  facts,  may  not  any  Osteopath  see  the  tre- 
mendous significance  from  his  standpoint  of  slight,  or  it  may  be  severe, 
sprains,  slips,  twists,  subluxations,  injuries,  exposures,  and  the  like?  Can 
he  fail  to  recognize  the  importance  of  such  factors  in  the  causation  of 
disease,  or  can  he  disregard  the  therapeutic  value  of  their  removal?  It 
seems  that  when  we  look  at  these  things  from  an  Osteopathic  standpoint, 
they  become  fraught  with  great  significance,  and  to  my  mind,  nothing  is 
more  encouraging  to  an  Osteopath  than  the  thought  that  he  can  go 
about  to  remedy  these  pathological  results.  1  have  brought  this  up  be- 
cause it  seemed  to  me  that  these  were  Osteopathic  points.  Hence,  you 
will  note  the  importance  of  what  we  have  said  in  previous  lectures,  that 
you  should  always  and  under  all  circumstances  look  for  lesions.  You 
should  always,  also,  inquire  into  the  history  of  the  case. 

The  method  of  questioning  is  one  of  the  valuable  means  by  which 
we  diagnose  the  case,  it  is  the  only  thing  that  leads  us  into  the  history 
of  the  case. 

These  lesions,  such  as  described,  are  of  particular  importance  to  the 
Osteopath  because  a  contraction  may  cause,  for  instance,  DISTORTION  OF 
A  PART,  as  we  frequently  find  in  our  practice.  When  a  part  has  left  its 
normal  position  it  may  very  likely  be  obstructing  some  of  the  fluids  of 
life,  or  pressing  upon  important  parts,  producing  disease.  So  that  the  result 
of  the  lesions  may  not  only  be  distortions  but  may  be  obstructions  of  parts ; 
further,  they  may  lead  to  ANKYLOSIS  OR  OSSIFICATION  of  the  parts.  Quain's 
Dictionary,  in  speaking  of  Pott's  disease,  says,  "In  the  majority  of  cases 
ulceration  of  one  or  more  interverttibral  cartilages  occurs  as  a  result  of 
sub-acute  inflammation;  if  the  case  proceed  favorably  toward  a  curative 
termination,  the  destructive  process  becomes  arrested,  and  a  healthy  pro- 
cess is  re-established,  terminating  in  bony  ankyjosis  between  the  bodies 
of  the  vertebrae;  ossification  also  spreads  along  some  of  the  ligamentous 
structures  passing  between  the  laminae,  as  well  as  between  the  spinous 
processes.''  "Thus,"  he  goes  on  to  say,  "the  resulting  posterior  pro- 
trusion becomes  a  persistent  deformity,  a  deformity  essential  to  the  cure 
of  the  disease."  Pott's  disease,  I  might  say,  is  the  extreme  posterior 
curvature  of  the  spine,  also  commonly  called  hunch-back.  Now,  as  to 
this  explanation,  there  are  several  points  to  which  I  wish  to  invite  your 
attention.  In  the  first  place,  it  emphasizes  the  importance  of  inflamma- 
tion, as  he  says  the  condition  may  result  from  inflammation  between 
the  bodies  of  the  vertebrae.  Further,  that  the  inflammation  may  be  the 
result  of  some  rheumatic  process  started  in  the  ligaments  about  the 
spine.  Second,  that  the  result  may  be  ankylosis  or  ossification,  if  the 
case  has  gone  far  enough.  Third,  to  the  Osteopath  it  is  difficult  to  call 
a  deformity  a  cure;  that  is  what  we  call  disease;  patients  come  to  us  with 


THEORY   OF    CENTERS.      CERTAIN   LESIONS.  83 

•deformities  to  Ibe  cured.  It  has  been  a  matter  of  some  surprise  that  I 
noticed  that  not  only  Quain,  but  others,  for  instance,  Hilton,  speak  of 
cure  by  fixation  or  ossification  of  parts.  Now.  I  do  not  call  this  to  your 
attention  to  tell  you  that  you  can  cure  ankylosis  of  the  vertebras.  How- 
ever, there  is  a  kind  of  ankylosis  that  may  be  cured  by  the  Osteopath 
and  that  is  the  ligame-ntous  form.  When  it  has  reached  ossification  it  is 
beyond  our  power.  What  the  Osteopath  is  called  upon  to  do  in  such  a 
case,  where  there  is  fixation  of  parts  of  bony  growth,  is  to  give  relief  or 
perhaps  strengthen  the  general  condition  of  the  body,  which  he  can  very 
frequently  do.  The  peculiar  woik  of  the  Osteopath,  in  cases  which  are 
proceeding  to  such  a  termination,  is  not  that  he  may  remove  the  anky- 
losis or  the  ossification,  but  that  he  may  prevent  is  forming.  Our  prac- 
tice justifies  the  statement  that  he  can  prevent  such  things.  A  great  many 
cases  of  spinal  curvature  have  been  cured  outright,  and  there  is  no  telling 
what  the  termination  of  such  a  case  of  spinal  curvature  might  have  been. 
It  might  have  gone  on  to  ossification  or  ankylosis  of  the  joints.  The 
facts  are  that  cases  of  deformity  have  been  saved  from  being  permanent, 
and  that  people  have  been  saved  from  the  lives  of  cripples  time  and  again 
by  Osteopathic  therapeutics.  And  so  these  things  are  significant  to  us 
more  in  a  prophylactic  light,  that  is,  that  we  may  prevent  their  growth. 

For  examples  of  the  general  cause  of  disease  following  a  slip  or 
strain  which  have  rerulted  in  a  thickening  of  ligaments.  I  wish  to  note 
several  cases:  I  have  had  cases  in  which,  along  the  region  of  the  splanch- 
nic nerves,  there  was  a  tightening  of  all  the  ligaments,  the  parts  of  the 
spine  being  approximated.  The  result  of  that  lesion  was  some  form  of 
stomach  trouble.  I  have  seen  a  case  of  neurasthenia,  which  I  would 
attribute  to  such  a  cause.  When  practicing  in  Chicago,  we  had  a  gentle- 
man who  was  in  rather  a  remarkable  condition.  His  general  trouble 
might  be  described  as  neurasthenia.  His  trouble  was  largely  circulatory 
and  nervous.  He  had  a  skin  as  soft  as  a  baby's  almost;  a  ruddy  com- 
plexion; looked  strong  and  healthy,  and  one  would  hardly  think  there 
was  anything  wrong  with  him.  But  he  said  he  would  at  almost  any  time 
break  out  into  a  perspiration,  when  there  was  not  any  heat  at  all  or  exer- 
tion to  account  for  it,  or  perhaps  he  would  be  chilly.  Then,  again,  he 
would  flush  up  following  any  exertion.  He  would  have  trouble  with  his 
head,  and  could  not  work  at  times.  Again  he  would  be  bothered  with 
sleeplessness.  Now.  those  were  general  nervous  troubles  and  troubles 
of  the  circulation.  He  was  a  man,  who  on  account  of  his  disease,  led 
practically  an  outdoor  life.  The  lesion  in  his  case  was  along  the  spine. 
We  found  that  the  ligaments  along  the  spine  were  tightened,  and  that 
the  muscles  were  contracted.  ) 

Now,  whether  or  not  the  theory  fits  the  facts,  and  whether  or  not  all 
these  things  are  brought  out  properly,  they  explain,  at  least  theoreticallv, 


84  LANDMARKS   OF   THE   NECK. 

what  we  do  when  we  meet  similar  cases  and  go  to  work  to  remove  such 
lesions.  Such  lesions  then,  may  come,  first,  by  direct  impingement  and 
irritation  of  the  nerves.  As,  for  instance,  where  they  emerge  from  the 
spine  at  the  intervertebral  foramina.  Second,  they  may  act  through  the 
blood  supply,  as  was  shown  in  a  lecture  or  two  since,  by  causing  anemia 
or  hyperemia  of  the  centers  or  the  nerves.  This  hyperemia  or  anemia 
may  be  collateral  on  account  of  the  condition  of  the  circulation  to  the 
spinal  muscles,  or  the  anemia  tray  exist  directly  by  pressure  at  the  inter- 
vertebral  foramina  on  the  anterior  and  posterior  spinal  nerve  branches, 
or  perhaps  by  pressure  in  the  same  way  on  the  vertebral  branches  of  the 
arteries,  and  thus  shutting  off  the  blood-supply  to  the  cord. 

II.  LANDMARKS  CONCERNING  THE  NECK:— (Continued.) — 
Holden  notes  the  sterno-mastoid  muscles,  which  he  calls  the  surgical 
land-mark  of  the  neck,  and  calls  to  our  attention  the  fact  that  it  stands 
out  in  relief  when  acting  to  turn  the  head  toward  the  opposite  shoulder. 
Behind  its  inner  border  lies  the  pneumogastric  nerve,  -in  the  same  sheath 
with  the  common  carotid  artery  and  the  internal  jugular  vein.  The  com- 
mon carotid  artery  runs  as  far  as  the  upper  level  of  the  thyroid  cartilage, 
where  it  branches  into  the  internal  and  external  carotids;  its  course  corre- 
sponds to  a  line  drawn  from  the  sterno-clavicular  articulation  to  a  point 
midway  between  the  angle  of  the  lower  jaw  and  the  mastoid  process. 
Note  the  interval  between  the  sternal  and  clavicular  origins  of 
the  sterno-mastoid  muscle.  Just  behind  this  interval  lies  the 
common  carotid  artery  internally,  the  external  jugular  vein  ex- 
ternally. Between  them,  and  a  little  posteriorly,  lies  the  pneu- 
mogastric nerve.  The  sterno-clavicular  joint  is  important.  Be- 
hind it  lies  the  commencement  of  the  vena  innominata.  It  is  the  level 
of  the  division  of  the  innominate  artery  on  the  right,  and  the  level  of  the 
apex  of  the  lung.  As  to  the  apex  of  the  lung,  it  may  rise  one  and  a  half 
inches  and  perhaps  two  inches  above  the  sterno-clavicular  joint.  This 
is  the  part  of  the  lung  which  is  least  apt  to  be  inflated  with  air,  and 
hence  very  apt  to  be  the  seat  of  disease.  I  have  already  called  your  atten- 
tion to  its  examination  by  percussion  at  the  sternal  end  of  the  clavicle. 
The  subclavian  artery  is  also  importat't.  In  the  supra-clavicular  fossa, 
just  at  the  outer  edge  of  the  sterno-mastoid  muscle,  about  an  inch  above 
the  clavicle  you  will  feel  the  pulsation  of  the  subclavian  artery;  at  that 
point  it  crosses  the  first  rib.  Pressure  slightly  downward  and  inward 
there  will  impinge  upon  the  subclavian  artery,  a  little  pressure  is  suffi- 
cient. As  you  knew,  the  outer  border  of  the  sterno-mastoid  muscle  cor- 
responds nearly  to  the  anterior  border  of  the  scalenus  anticus  muscle, 
and  that  across  the  scalenus  anticus  runs  the  phrenic  nerve.  Now,  at 
about  the  point  where  you  impinge  upon  the  subclavian  artery  you  will 
also  reach  the  phrenic  nerve.  In  fact,  the  way  Dr.  Harry  Still  often  treats 


EXAMINATION    OF   THE   NECK.  85 

hiccoughs  is  by  standing  behind  the  patient  and  placing  his  thumb  along 
the  outer  edge  of  the  sterno-mastoid  muscle,  thus  reaching  the 
phrenic  nerve.  Deep  pressure  at  the  upper  (outer)  part  of  the  supra- 
clavicular  fossa  will  reach  the  transverse  process  of  the  seventh  cervical 
vertebra.  In  a  long  thin  neck  it  is  stated  that  just  above  and  nearly 
parallel  with  the  clavicle  can  be  felt  the  posterior  belly  of  the  omo-hyoid 
muscle,  as  it  rises  and  falls  in  inspiration. 

III.  I  wsh  to  continue  the  EXAMINATION  OF  THE  NECK.— 
(Continued.) — There  were  a  couple  of  points  that  I  should  have  noted  in 
going  over  the  spine,  but  they  slipped  my  mind  at  the  time.  One  of 
them  is  how  to  stretch  the  quadratus  lumborum  muscle.  This  muscle  in 
various  cases  will  become  contracted  and  will  then  draw  down  the  lower 
rib,  and  may  make  considerable  trouble.  I  have  found  that  I  could 
treat  a  lame  back  in  that  way  and  get  results  that  I  could  get  in  no 
other.  Frequently  the  lameness  is  between  the  fifth  lumbar  and  the 
sacrum,  because  the  traction  in  the  quadratus  lumborum  muscle  is  draw- 
ing the  pelvis  up  and  is  bringing  a  strain  at  the  point  of  junction  of  the 
fifth  lumbar  with  the  sacrum.  I  have  often  removed  lameness  there  by 
stretching  that  muscle.  It  takes  a  diagonal  pull  to  stretch  the  quadratus 
lumborum  properly.  If  I  have  an  assistant  I  have  him  draw  on  the  pelvis 
while  I  draw  the  arm  obliquely  in  the  other  direction.  I  draw  steadily, 
but  do  not  jerk,  and  p,ut  a  considerable  force  of  traction  upon  the  part. 
Then  I  have  my  assistant  take  the  arm,  and  I  stretch  in  the  other  direc- 
tion, and  in  that  way  I  get  traction  upon  every  part  of  the  quadratus 
lumborum  muscle. 

The  other  point  concerning  the  spine  was,  that  you  will  in  passing 
your  hand  over  the  back,  frequently  detect  CHANGES  IN  TEMPERATURE.  You 
will  find  a  warmer  spot,  or,  more  frequently  a  cold  streak  following  the 
distribution  of  the  inter-costal  nerves.  That  is  quite  an  important  method 
of  diagnosis.  You  should  accustom  your  hand  to  detect  differences  in 
temperature.  That  has  to  be  done  next  to  the  skin.  When  you  find  that 
it  indicates  at  once  that  the  blood-supply  is  not  equally  distributed,  and 
that  probably  there  is  a  lesion  along  the  spine  at  the  point  where  the  cold) 
streak  leaves  it.  If  you  find  it  hot  it  may  mean  the  same,  but  we  do  not 
find  that  as  often  as  we  do  the  cold  streak. 

In  the  consideration  of  the  neck  I  have  divided  it  into,  FIRST,  THE; 
THROAT,  which  I  considered  at  the  last  lecture;  SECOND,  THE  NECK  PROPER; 
which  I  shall  consider  at  this  time.  I  have  already  noted  the  spines  and 
and  the  peculiar  vertebrae,  and  the  fact  that  you  can  note  the  dislocated 
vertebra  sometimes  by  an  examination  in  the  pharynx  by  means  of  the 
finger.  I  have  called  the  atlas  to  your  attention,  and  the  fact  that  you 
must  turn  the  head  from  side  to  side  in  attempting  to  examine  the  artic- 
ular process  of  the  vertebrae.  In  a  case  of  fracture,  which  we  may  possi- 


86  EXAMINATION   OF  THE  NECK. 

bly  find,  there  will  be  crepitus  and  abnormal  mobility  of  the  parts.  You 
should  in  your  examination  of  the  neck  look  at  the  condition  of  the  super- 
ficial and  deep  muscles.  Carefully  examine  to  note  any  hardening  of  the 
•muscles.  The  hardening  may  be  in  the  superficial  muscles  or  in  the  deep 
muscles;  you  will  have  to  judge  as  to  where  the  tightening  of  the  muscle 
is.  Examine  very  carefully  all  about  the  superficial  and  deep  muscles.  It 
is  usually  in  the  throat  that  you  find  the  superficial  muscles  contracted, 
and  the  deeper  ones,  in  the  neck  further  back.  The  sterno-mastoid  muscle 
of  course  always  comes  prominently  to  your  attention.  It  is  contracted  in 
cases  of  torticollis ;  or  it  may  be  hardened  and  produce  pressure  upon  the 
structures  beneath  it.  Then  examine  the  scaleni  muscles.  You  know  how 
they  are  attached,  reaching  all  the  way  from  the  second  cervical  down  to 
the  seventh,  then  to  the  two  upper  ribs.  Normally  these  muscles  will  feel 
rather  hard,  you  will  become  acquainted  with  the  normal  feeling  of  them. 
They  are  significant  to  us  from  the  fact  that  they  sometimes  become 
contracted  and  bring  traction  upon  the  upper  two  ribs.  Hence  it  is  that 
any  displacement  .of  these  upper  two  ribs  is  very  likely  to  be  upwards. 
This  will  cause  heart  trouble,  or  lung  trouble,  etc.  These  muscles  are 
useful  in  replacing  ribs  which  are  dislocated.  I  have  already  noted  the 
ligamentum  nuchae;  how  you  may  find  it  and  how  you  may  treat  it.  The 
neck  is  about  as  good  a  place  as  there  is  for  the  Osteopath  to  find  sore 
spots.  Principally  you  are  liable  to  find  them  in  the  fossae  just  below  the 
occipital  bone.  In  the  normal  neck  there  is  no  soreness  there.  Of 
course  you  may  impinge  at  any  time  upon  a  nerve  hard  enough  to  hurt 
it.  Why  these  sore  spots  occur  is  hard  to  say,,but  I  think  the  soreness 
is  due  primarily  to  the  condition  of  the  great  and  sub-occipital  nerves 
which  you  find  at  that  point.  I  do  not  think  that  it  is  just  because  you 
touch  them,  'but  they  were  sore  before  you  touched  them.  Then  you 
will  often  find  that  just  below  the  occipital  protuberance  there  is  a  sore 
spot;  and  just  there  you  will  often  find  a  tightening  of  the  ligaments. 
The  lesion  is  important  because  if  you  find  a  sore  spot  there  or  in  the 
fossa  below  the  occipital  bone  you  are  led  to  believe  that  there  is  some 
irritation  affecting  the  sub  and  great  occipital  nerves,  and  since  they  are 
in  close  connection  with  the  superior  cervical  ganglion  of  the  svmpa- 
thetic,  they  may  have  an  effect  through  it  upon  the  distant  parts  of  the" 
body.  You  should  also  examine  in  the  region  of  the  three  ganglia  of  the 
sympathetic.  The  superior  cervical  ganglion  is  opposite  the  second  and 
third  vertebrae  on  the  rectus  capitus  anticus  major  muscle.  The  second  cer- 
vical ganglion  lies  opposite  the  sixth  and  seventh  cervical  vertebrae,  while 
the  inferior  cervical  ganglion  lies  just  below  the  seventh  cervical  verte- 
bra, and  is  frequently  coalesced  with  the  first  thoracic  ganglion  of  the 
sympathetic.  Quain  puts  it,  that  this  inferior  cervical  ganglion  of  the 
sympathetic  lies  just  over  the  costo-central  articulation,  that  is,  the  ar- 


LESIONS:    EXAMINATION  OF  THE  NECK.  87 

ticulation  of  the  first  rib  with  the  spine.  Now,  if  you  should  find  lesions 
in  those  places  they  are  significant  to  you  according  as  they  may  affect 
the  sympathetic  life  of  the  individual.  They  may  affect  the  brain,  heart 
and  lungs,  or  any  distant  part  of  the  body.  Also  remember  the  spinal 
nerves  here,  those  of  the  cervical  and  brachial  plexuses.  Impinge  upon 
these  nerves  where  they  pass  out  between  the  scalenus  anticus  and  scalenus 
medius  muscles,  and,  upon  deep  pressure  the  patient  will  tell  you  he  can  feel 
pain  in  his  shoulder 'and  arm.  You  should  also  here  look  at  the  temperature 
of  the  parts  you  are  examining,  and  I  think  that  nowhere  else  in  the  body  we 
as  frequently  find  a  cold  place  as  in  the  back  of  the  neck.  I  thought  that 
perhaps  it  was  because  it  was  more  exposed,  but  I  doubt  that  very  much 
because  I  have  treated  patients  who  had  been  in  the  house  for  hours, 
and  those  muscles  were  cold.  I  have  treated  patients  in  the  heated  period 
of  summer,  when  certainly  there  was  not  any  chance  of  there  being  ex- 
posure to  cold,  and  the  temperature  was  abnormally  low.  That  argues 
to  your  mind  certainly  that  there  is  some  inequality  in  the  distribution 
of  the  blood-flow,  it  may  be  a  tightening  of  the  muscles  upon  the  blood 
vessels,  but  it  shows  you,  at  any  rate,  that  there  is  the  seat  of  the  lesion. 
In  this  examination  you  must  look  at  the  condition  of  the  blood-supply  to 
the  throat  through  the  neck  and  thus  to  the  brain,  which  is  important,  and 
you  should  be  very  sure  that  the  blood-supply  to  the  neck  and  brain  are 
normal. 

Q.  You  spoke  of  treating  the  phrenic  nerve  above  the  clavicle. 
Could  it  not  also  be  reached  from  the  second  to  the  fifth  cervical? 

A.  Yes,  sir;  Dr.  Harry  Still  frequently  works  along  the  third, 
fourth  and  fifth  cervical.  The  phrenic  nerve  arises  from  the  fourth,  also 
partly  from  the  third,  and  has  a  connecting  branch  from  the  fifth.  So 
we  work  at  the  anterior  edge  of  the  scalenus  medius  and  impinge  upon 
the  nerve  by  pressing  backward  against  the  transverse  processes  of  the 
vertebrae. 


LECTURE   XIV. 

At  the  last  lecture,  I  considered  briefly  possible  lesions  of  centers.  I 
shall  carry  that  idea  further  to-day.  What  I  took  the  most  time  to  ex- 
plain was  how  thickening  the  connective  tissue  of  parts  might  lead  to 
impingement  upon  blood  vessels  or  upon  nerves,  showing  that,  in  the 
first  place,  there  might  be  an  irritation  caused  by  a  slip  of  a  vertebra, 
thus  setting  up  inflammation,  this  followed  by  formation  of  new  tissue 
which  has  a  tendency  to  contract.  I  showed  that  the  same  thing 
could  follow  hyperemia.  Such  things,  then,  are  significant  to  the  Osteo- 
path, since  they  act  as  obstructions  to  the  flow  of  blood  and  nerve  force. 


88  THEORY   Ot   CENTERS.      CERTAIN   LESIONS. 

Such  lesions  mayv  if  not  prevented,  go  much  further,  resulting  in  bony 
ankylosis  of  joints  or  in  ossification  of  ligaments,  setting  up  a  perma- 
nent deformity.  It  is  the  function  of  the  Osteopath  not  so  much  to 
treat  that  deformity,  as  to  prevent  it.  That  is.  .in  such  case  his  treat- 
ment is  prophylactic. 

I  then  called  your  attention  to  landmarks  in  the  neck,  and  to  cer- 
tain points  in  how  to  examine  the  neck. 

I.  THEORY  OF  WORK  UPON  CENTERS.— (Continued.)  — 
Further  possible  lesions.  You  may  have  a  pressure  upon  important  parts 
by  EXUDATES  OR  BY  OEDEMA.  An  exudate  is  in  nature  fluid  or  cellular,  and 
it  follows  pathological  processes  in  the  nature  of  inflammations  or  hy- 
peremia.  Having  an  inflammation,  you  have  an  exudation  ,of  the  con- 
tents of  the  blood  vessels,  those  contents  are  fluid,  or  in  the  later  stages 
of  the  exudation,  cellular.  They  thus  may,  at  'any  place,  and  do,  build 
up  a  considerable  thickening  among  the  tissues,  acting  as  a  mechanical 
pressure  or  irritant  upon  important  parts.  These  important  parts  may 
be  blood  vessels  or  nerves.  Byron  Robinson  says,  "The  nerves  may 
suffer  from  pressure  by  exudates  or  oedema,  congestion  or  from  malnu- 
trition. The  final  outcome  is  derangement  of  the  nerves,  exaltation  of 
sensation  and  motion,  or  debasement  of  sensation  and  motion."  He 
was  speaking  there  particularly  of  the  nerves  to  the  bowels.  The  Osteo- 
path's duty  in  relation  to  such  things  is  that  he  must,  in  making  his  diag- 
nosis, take  into  consideration  the  probability  of  there  being  such  a 
lesion  present.  You  will  in  your  further  studies,  which  will  include  path- 
ology and  other  important  things,  learn  how  to  recognize  these  lesions 
better  than  I  can  tell  you  here.  What  I  propose  to  do  is  to  use  these 
things  to  illustrate  the  subject  of  Osteopathy;  I  cannot  go  into  detail  and 
explain  everything  in  pathology  that  I  meet,  but  they  are  valuable 
to  you,  and  you  will  recognize  their  importance  when  you  come  to  that 
place  in  your  course.  In  general,  you  will  recognize  or  look  for  the  pro- 
cess of  oedema  in  patients  with  lung,  kidney  br  heart  trouble;  you  will 
be  very  apt  to  find  it  in  such  cases;  or  in  cases  where  there  is  obstruc- 
tion to  the  blood-flow.  It  may  be  mechanical  shutting  down  upon  an 
artery,  or  it  may  be  a  narrowing  of  the  1'imen  of  a  vessel  from  some 
disease,  or  something  of  that  kind.  The  Osteopath  must  judge  what 
may  be  the  cause  and  work  to  remove  the  lesion.  As  to  hyperemia, 
and  its  effects  upon  the  cord,  I  have  already  shown  this  to  you  in  a 
quotation  from  Green,  where  he  said  it  caused  paraesthesia  of  sight  or 
hearing,  or  perhaps  even  spasms.  But  according  to  Robinson,  this  hy- 
peremia may  act  mechanically  to  affect  not  centers  only,  but  directly  to 
affect  nerves  through  pressure.  Your  lesion  may  be  malnutrition,  (but  I 
will  notice  that  later.  Other  lesions  which  may  produce  pressure  upon  im- 
portant parts  are  DEPOSITS  OR  GROWTHS.  I  wish  to  quote  from  Dr.  Jacob- 


THEORY   OF   CENTERS.      CERTAIN    LESIONS.  89 

son,  Dr.  Hilton's  editor,  where  he  says,  "Sensations  of  sharp  pains  like 
knives  around  the  trunk,  increased  by  movement,  and  a  numbed  feel- 
ing about  the  body,  may  be  produced  by  gummatous  meningitis  making 
pressure  upon  the  posterior  roots  of  some  of  the  spinal  nerves."  You 
note  here  that  the  pathological  process  is  an  inflammation,  that  second- 
arily there  is  set  up  a  pressure  as  the  result  of  that  inflammation,  which 
is  a  gummatous  deposit,  thus  it  acts  as  a  lesion  producing  pressure.  Hil- 
ton instances  a  case,  further,  where  there  was  pressure  upon  the  ulnar 
nerve,  causing  much  numbness,  lack  of  sensation,  and  particularly  of 
motion,  in  the  third  and  fourth  fingers.  They  became  discolored,  and 
finally  gangrenous. .  Upon  examination  there  was  fcund  an  exostosis, 
an  outgrowth  from  the  bone,  upon  the  first  rib,  pressing  upon  the  ulnar 
nerve  and  the  subclavian  artery,  thus  shutting  oft  the  nerve  and  blood- 
supply  partly,  the  nerve  more  fully.  However,  shutting  off  the  nerve- 
supply,  alone,  would  have  been  sufficient  to  cause  degenerative  changes 
in  the  part  affected. 

I  wish  to  call  your  attention  to  this  STRUCTURAL  DEGENERATION  BY 
PRESSURE  upon  a  nerve.  You  may  have  pressure  in  the  form  of  a  foreign 
growth  or  in  the  form  of  some  excresence  upon  important  parts  Fur- 
ther, your  lesion  might  be  an  aneurism,  and  might  bring  pressure  upon 
parts.  Green  states  that,  ''active  congestion  follows  pressrre  upon  the 
sympathetic,  as  for  instance  in  the  neck  by  an  aneurism."  It  may  inhibit 
vaso-tonic  action  of  the  sympathetic  and  cause  hyperemia.  or  the  reverse. 

Another  kind  of  lesion  which  will  frequently  come  to  your  attention  is 
tumor,  which  you  will  notice  also  is  of  such  a  nature  that  it  produces  pres- 
sure upon  important  parts.  You  might  take,  for  instance,  the  case  of  ex- 
ophthalmic goitre;  there  you  have  protrusion  of  the  eye  ball  due  to  a 
deposition  of  fat  behind  it.  That  shows  an  over  stimulation  of  the 
trophic  fibers  to  jliat  part  of  the  head.  There  are  also  cardiac  symp- 
toms, palpitation  and  irregularity  in  the  beat  of  the  heart,  which  show 
an  interference  with  the  cardiac  nerves,  the  sympathetics  receiving  pres- 
sure from  the  goitre  in  the  neck.  And  further,  you  have  vaso-motor 
symptoms  from  the  pressure  of  this  goitre,  because  you  frequently  have 
a  flushing  of  the  cutaneous  circulation.  This  is  a  good  example  of  what 
mechanical  pressure  may  do  to  influence  nerve  life.  Robinson  also  in- 
stances the  case  of  an  abdominal  tumor  leading  to  fatty  degeneration  of 
the  heart.  The  impulse  is  sent  from  the  tumor  along  the  abdominal 
sympathetics  to  the  solar  plexus,  here  it  is  reorganized,  perhaps  sent  to 
the  cervical  sympathetics,  down  the  cardiac  branches  to  the  heart,  re- 
sulting in  irritation  and  irregularity  of  the  heart,  causing  the  heart  to 
overfeed  itself._jvhich  finally  results  in  hypertrophy,  followed  by  fatty 
degeneration.  Thus  you  can  learn  to  trace  the  causes.  Almost  any 


90  THEORY   OF    CENTERS.      CERTAIN   LESIONS. 

young  Osteopath  would  treat  that  effect,  heart  trouble,  when  really  it  is 
the  tumor,  far  removed  from  the  heart,  which  is  the  cause  of  the  trouble. 

In  speaking  of  abdominal  tumors,  Robinson  says,  "The  irritation 
from  the  tumor  is  carried  on  the  plexus  of  any  contiguous  viscus  to 
the  abdominal  biain,  where  it  is  reorganized  and  emitted  to  the  digest- 
ive tract  over  the  gastric  plexus,  the  superior  mesenteric  plexus  and  the 
inferior  mesenteric  plexus.  In  any  case  the  brunt  of  the  forces  end  in 
the  ganglia  which  lie  just  below  the  mucous  membrane.  The  ganglia 
constitute  what  is  known  as  Meissner's  plexus,  which  rules  secretion.  If 
the  irritation  be  of  such  a  nature  as  to  produce  execessive  secretion, 
diarrhoea  may  result;  the  excessive  secretions  will  decompose  and  induce 
malnutrition."  Thus  one  difficulty  leads  to  another.  You  might  have 
constipation,  indigestion  and  various  troubles.  He  goes  on  to  say 
that  small  tumors  on  pedicles,  so  that  they  may  swing  around,  roll  about, 
and  pound  upon  the  abdominal  structures,  are  those  which  are  most  in- 
jurious, for  obviously,  if  the  tumor  is  fixed,  it  will  not  iiritate  much." 
but  if  it  rolls  about  it  will  keep  irritating  the  sympathetics  and  aggravat- 
ing the  trouble^ 

The  lesions  given  above  are  the  lesions  which  produce  pressure  in  the 
body,  pressure  upon  important  structures,  for  the  most  part  nerves.  I 
have  already  in  my  lectures  noted  certain  results  that  you  would  get  from 
pressure  upon  nerves,  for  instance,  irritation,  stimulation,  inhibition, 
hyperemia,  anemia,  etc.  But  I  wish  to  go  further  to-day,  and  show  that 
the  result  may  be  more  serious  than  a  mere  inhibition  or  stimulation,  that 
it  may  lead  to  DEGENERATION  OF  THE  NERVE  FIBERS.  Thus  there  would  be 
processes  of  deterioration  of  the  structure  of  the  parts,  especially  the 
nerves  affected.  The  process  of  degeneration  of  the  nerves  is  as  fol- 
lows, and  is  called  secondary  degeneration,  since  it  is  secondary  to 
some  primary  lesion;  it  is  also  called  Wallerian  degeneration.  The 
first  process  is  that  the  myelin  becomes  degenerated,  the  sheath  of 
Schwann  becomes  separated  into  parts,  still  later  it  becomes  granulated, 
and  finally  disappears  from  the  nerve  sheath,  perhaps  by  the  process 
of  saponification,  as  has  been  suggested  by  some  writers.  During  this 
process,  the  axis-cylinder,  which  is  the  important  part  of  the  nerve,  is 
segmented,  broken  down,  and  removed  in  practically  the  same  way. 
Thus  you  finally  have  nothing  but  the  nerve  sheath  left  The  nerve 
has  then  lost  its  conductivity  and  is  useless  as  a  nerve.  What  I  wish 
to  show  is  that  pressure  upon  nerves  may  be  bad  enough  to  induce  this 
degeneration,  which  you  can  readily  see  is  a  serious  result.  Gowers  says, 
"Degeneration  follows  many  slight  lesions  of  nerves;  compression,  over 
extension,  and  the  like."  He  says  further  that  it  is  probable  that  a  com- 
pression for  a  few  hours  has  such  an  effect  in  separating  the  molecules 
in  the  white  substance  of  Schwann  as  to  set  up  a  secondary  degeneration 


THEORY  OF   CENTERS.-     CERTAIN   LESIONS.  91 

of  the  same  character  as  that  resulting  from  division  of  the  nerves.  This 
pressure  does  not  need  to  be  severe;  it  may  not  extend  over  a  period 
longer- than- a  few  hours  to  produce  finally  all  the  results  which  the 
Osteopath  meets  in  his  work.  Pressure  of  some  dislocated  part  or 
pressure  of  some  such  lesion  as  I  have  mentioned  to-day,  upon  nerves, 
interferes  with  the  sense  of  feeling  and  with  structure  of  other  parts,  and 
may  have  an  effect  similar  to  cutting  the  nerve.  Gowers  says  that 
after  division  of  a  nerve  or  degeneration  of  its  fibers,  there  is  a  marked 
change  in  the  muscles  supplied  by  the  motor  nerve.  This  is  a  change 
which  is  a  deterioration  of  their  structure. 

So  much,  then,  for  lesions  which  may  be  brought  on  by  pressure.  You 
have  seen  from  what  I  have  said  what  this  pressure  may  result  from.  I 
wish  to  call  your  attention  to  the  fact  that  the  action  of  muscles  may,  in 
certain  cases,  become  traumatic,  wounding  a  nerve,  and  setting  up  nervous 
results,  often  degeneration.  Gowers,  speaking  of  neuritis,  says,  "Nerves 
are  sometimes  damaged  by  a  violent  contraction  of  muscles  through 
which  they  pass.  It  is  probable,  also,  that  muscular  action  excites  neur- 
itis in  other  situations,  especially  in  persons  who  are  predisposed." 

Also  we  may  notice  the  indirect  result  of  traumatic  lesion  by  action 
of  the  muscles.  Byron  Robinson,  in  speaking  of  peritonitis,  says,  "Peri- 
tonitis is  due  to  two  causes,  of  which  I  will  name  one,  viz,  traumatic  mus- 
cular action  of  the  psaos  magnus  on  the  sigmoid,  and  traumatic  muscu- 
.  lar  action  of  the  lower  right  limb  of  the  diaphragm  on  uie  descending 
colon."  The  way  by  which  the  nerves  there  are  involved  is  this,  That 
that  injury  allows  the  migration  of  pathogenic  bacteria,  which  set  up 
peritonitis,  thereby  crippling  the  nerves,  and  perhaps  causing  considerable 
degeneration  of  them.  And  this  traumatic  lesion,  directly  by  action  of 
muscles  upon  nerves,  or  indirectly  as  in  the  latter  case,  is  an  important 
thing  to  the  Osteopath,  and  he  must  take  it  into  consideration  in  diag- 
nosing his  cases.  You  will  learn  later  thai  these  nerves  when  degener- 
ated, max,  by  appropriate  treatment,  of  which  rest  and  quiet  is  an  im- 
portant part,  be  regenerated. 

To  illustrate  the  results  of  pressure,  take  a  case  of  which  Dr.  Hil- 
ton speaks,  being  a  case  of  fracture  of  the  radius.  The  callus,  in  the 
growing  together  of  the  bone,  had  pressed  upon  the  median  nerve  above 
the  wrist,  and  there  had  resulted,  not  a  paralysis,  but  an  ulceration 
upon  the  skin  of  the  thumb  and  first  and  second  fingers.  He  alto  notes 
a  case  in  which  pressure  of  the  humerus  upon  the  brachial  plexus  has  re- 
sulted in  a  wasting  of  the  deltoid  muscle  by  insufficient  nerve  supply 
from  the  circumflex  nerve,  which  had  been  impinged  upon.  That  em- 
phasizes the  importance  and  necessity  of  taking  into  consideration'every- 
thing  which  may  bring  pressure  upon  parts. 


$2  TREATMENT   OF   THE   NECK. 

Your  lesion,  as  I  have  stated,  may  be  malnutrition.  I  have  already 
explained  that  to  .some  extent.  Anemia  may  affect  not  only  centers 
in  such  cases,  but  it  may  affect  nerve  fibers  directly,  or  the  malnutrition 
may  be  from  a  poor  quality  of  blood. 

The  question  comes  to  you,  what  can  an  Osteopath  do  in  such  cases? 
Can  he  remove  exostosis,  aneurisms,  and  such  things  as  that?  No,  he  can 
not.  If  you  have  a  case  of  exostosis,  it  is  a  surgical  case.  Aneurism  has 
usually  to  be  treated  by  surgical  means.  I  have  called  these  things  to 
your  attention  on  account  of  their  importance,  and  to  lead  you  to  be 
on  your  guard.  You  should  not  take  secondary  symptoms  and  treat 
them.  Be  on  your  guard  always  in  making  your  diagnosis.  Some  of 
these  lesions  you  may  remove,  such  as  the  exudates  in  hyperemia  or  in- 
flammation, or  the  gummatous  tumor  in  meningitis,  also  the  goitre  press- 
ing upon  the  sympathetic.  All  these  things  are  subject  to  your  treat- 
ment. 

II.  HOW  TO  TREAT  A  NECK:— I  have  called  your  attention  to 
how  to  examine  the  neck.  I  wish  to  say  to  you  that  it  is  an  extremely 
important  thing  that  you  treat  the  neck  carefully,  for  the  treatment  of 
the  neck,  more  than  any  other  part  of  the  body,  is  to  be  done  with  great 
care  by  the  Osteopath.  As  in  the  consideration  of  the  examination  of  the 
neck,  I  first  take  up  the  throat,  so  in  the  treatment  I  will  notice  that  part 
of  the  subject  first.  In  treating  the  throat  your  first  duty  is  almost  always 
to  note  whether  there  be  a  contraction  of  the  hyoid  muscles,  and  if  such 
be  the  case  to  relax  them,  as  that  leaves  a  free  field  in  which  to  work,  since 
they  may  mask  other  troubles  which  you  may  not  notice  without  having 
that  removed  first.  Your  TECHINIQUE  OF  MANIPULATION  must  be  carefully 
noted,  and  the  degree  of  force  which  you  exert,  because  there  are  import- 
ant structures  which  you  may  injure  by  rough  pressure.  The  best  way  is 
•to  use  the  flat  of  the  hand,_  the  cushions  of  your  fingers.  To  relax  the 
muscles  here  the  best  way  is  to  push  the  head  toward  the  side,  that  is, 
away  from  you,  while  drawing  the  other  hand  towards  you.  You  do  not 
have  to  rub  your  fingers  over  the  neck.  Draw  the  muscles  with  the  fin- 
gers, do  not  let  them  slip  over  the  surface,  but  hold  against  the  muscles 
and  draw  them  toward  you.  You  can  do  this  work  as  thoroughly  as 
possible  without  any  rough  rubbing;  necks  are  readily  chafed  sometimes, 
and  if  you  wish  to  save  the  patient  to  your  practice  you  will  have  to 
be  a  little  careful  how  you  handle  his  neck. 

Next  as  to  the  TONSILS.  When  you  find  an  enlarged  tonsil,  the  first 
thing  to  do  is  to  loosen  the  muscles  over  the  blood-supply  to  the  tonsil, 
which  is  from  branches  from  the  carotid  arteries.  If  you  have  relaxed  all 
the  muscles  about  the  tonsils,  both  internal  and  external,  so  that  there 
is  no  further  impingement  upon  the  blood-supply,  then  you  have  relieved 
the  lesion.  If  the  lesion  is  back  in  the  vertebne  of  the  neck,  causing 


TREATMENT  OF  THE  NECK.  93 

the  nerves  to  shut  down  on  the  vaso-motor  supply  you  must  attend  to 
that. 

Generally  we  work  directly  in  this  way.  Give  it  a  thorough  treat- 
ment, but  not  too  hard.  Work  along  the  angles  of  the  jaw,  and  then 
work  down  along  the  course  of  the  common  carotid  artery,  as  far  as 
where  the  artery  comes  from  the  thorax,  just  behind  the  edge  of  the 
sterno-mastoid  muscles.  That  should  be  done  thoroughly;  you  should 
not  be  in  a  hurry.  Further,  I  always  put  my  fingers  behind  the  clavi- 
cle; be  careful  in  putting  your  fingers  there  not  to  hurt,  because  it  is  a 
very  tender  point.  I  always  put  my  fingers  there,  and  then  approximat- 
ing the  bent  arm  to  the  face,  press  it  on  above  and  over  the  head,  while 
my  fingers  lie  between  the  clavicle  and  the  first  rib.  This  relaxes  every- 
thing; then  bring  the  arm  down  over  the  head,  outward  and  down- 
ward; this  will  stretch  the  parts  and  stimulate  the  flow  of  blood  through 
the  carotid  artery.  Perhaps  the  chief  value  of  that  movement  is  that 
we  frequently  find  that  the  muscles  about  the  upper  part  of  the  thorax 
are  drawn  and  are  making  some  impingement  upon  or  stoppage  of  the 
blood-flow  through  the  carotid  artery,  and  you  give  it  freer  action  by 
the  motions  you  use.  We  also  frequently  stretch  the  jaw,  as  we  call  it. 
I  put  my  fingers  just  below  the  inferior  maxillary  bone,  placing  the 
thumbs  above,  usually  upon  the  malar-  processes,  then  holding  fairly 
tight,  spring  the  mouth  open,  rubbing  downward  as  the  mouth  opens,  to 
relax  the  muscles.  That  should  be  done  three  or  four  times.  It  is  not 
a  bad  idea  to  hold  the  jaw  firmly,  tell  the  patient  to  open  the  mouth 
while  you  are  holding,  and  that  will  stretch  the  muscles  about  the  part. 

In  treating  any  part  you  must  watch  its  blood  and  nerve  supply. 
We  have  mentioned  the  blood-supply  in  this  instance.  The  nerve-supply 
is  from  the  pneumogastric,  and  from  Meckel's  Ganglion  of  the  fifth. 
You  can  stimulate  the. pneumogastric  at  its  exit  from  the  skull  by  deep 
pressure.  You  can  also  effect  Meckel's  ganglion  by  having  the  patient 
open  his  mouth,  and  thrusting  the  fingers  into  the  glenoid  fossa,  have 
him  close  it  again.  It  will  usually  hurt,  but  it  is  supposed  to  have  an 
effect  upon  Meckel's  ganglion,  which  I  will  show  later  when  I  tell  you 
how  to  treat  the  neck.  The  point  there  is  the  communication  of  the 
sympathetic  with  the  pneumogastric  and  with  the  fifth  and  with  the 
blood  supply  about  the  fonsils.  Thus  you  have  treated  both  the  nerve 
and  blood  supply  in  treating  an  enlarged  tonsil.  If  your  diagnosis  has 
shown  you  a  tender  point  just  below  the  angle  of  the  jaw,  as  is  stated 
to  be  the  case  in  catarrh,  the  best  way  to  attend  to  it  is  by  the  means 
already  given,  viz.,  relaxing  all  the  parts.  In  that  way  you  will  throw 
fresh  life  there  and  take  away  the  pain  and  tenderness. 

*Should  you  find  lympathic  glands  enlarged  it  is  a  mistake  to  go  at 


*See  appendix  6. 


94  TREATMENT  OP  THE  NECK. 

them  and  treat  them  directly.  If  they  are  enlarged  it  is  from  some  rea- 
son. You  will  sometimes  find  them  enlarged  in  tonsilitis  or  in  diph- 
theria. They  are  enlarged  because  they  have  work  to  do  as  scaven- 
gers, and  you  must  look  to  the  original  cause.  I  do  not  think  it  ad- 
missible ever  to  work  directly  upon  those  lymphatics,  thinking  that  that 
will  take  down  the  enlargement,  especially  in  acute  cases.  It  may  pos- 
sibly do  in  chronic  cases,  but  in  acute  cases  I  have  known  of  injury  being 
done  by  rough  treatment  of  enlarged  lymphatic  glands  when  the 
trouble  was  somewhere  else. 

Q.  In  the  case  of  tonsilitis,  would  you  not  stimulate  the  blood  away 
from  the  tonsils. 

A.  When  you  have  stimulated  the  arterial  supply,  you  will  sweep 
away  the  congestion.  "Whenever  you  have  Sttended  to  the  nerve-supply 
there,  regulating  the  blood,  the  vaso-motors,  of  course  then  you  get  the 
same  effect,  it  all  tends  toward  the  normal  and  to  restore  the  circulation 
as  it  should  be. 

Q.     Increasing  the  arterial  flow  will  sweep  away  the  congestion? 

A.  Yes,  that  is  the  tendency;  that  is  how  you  can  affect  congestion 
through  blood-supply,  but  do  not  forget  to  couple  it  with  nerve-supply, 
vaso-mo^or. 

Q.  I  thought  the  way  to  get  at  it  was  to  drain  the  congested  part 
by  venous  withdrawal. 

A.  That  comes  partly  through  your  vaso-motor  effect,  but  if  you 
can  get  sufficient  "vis  a  tergo"  to  sweep  that  all  out,  that  is  all  you  need, 
and  that  is  readily  done. 

Q.  Do  you  always  have  a  local  oedematous  condition  with  inflam- 
mation ? 

A.  I  do  not  know  that  there  can  be  an  inflammation  without  oedema 
• — without  an  exudation;  that  is  one  of  the  important  symptoms  of  in- 
flammaiion. 

Q.     Do  you  treat  the  sympathetics  for  goitre? 

A.  The  cervical  ganglia,  all  three  of  them,  I  would  treat,  but  would 
especially  direct  my  attention  to  loosening  the  anterior  and  posterior 
muscles,  with  the  idea  of  relieving  all  parts  and  allowing  a  free  flow 
of  blood  and  nerve  force.  Of  course  you  must  do  here,  as  you  always 
do,  look  for  the  lesion.  You  may  find  the  clavicle  is  slipped,  or  you 
may  find  that  one  of  the  vertebrae  is  displaced — it  depends  upon  the 
cause. 


GENERAL    CONSIDERATIONS.  95 

LECTURE  XV. 

At  the  last  lecture  I  considered,  under  the  general  subject  of  theory  of 
work  upon  centers,  further  lesions  that  you  might  meet  in  your  work. 
I  noted  that  you  might  have  pressure  by  exudates  or  edema;  that  the 
exudate  might  be  fluid  or  cellular;  that  the  Osteopath  must  take  into 
consideration  the  possibility  of  such  lesions  and  be  on  the  lookout  for 
them,  thus  going  into  the  history  of  the  case.  For  instance,  if  there  is  a 
history  of  inflammation,  you  will  look  for  such  a  possible  lesion,  or  if  a 
history  of  congestion,  you  will  look  for  that  lesion.  The  lesion  may  be  a 
congestion  bringing  pressure  upon  parts,  or  it  may  be  malnutrition;  it 
may  be  some  kind  of  a  deposit,  for  instance  a  gummatous  deposit,  of 
which  I  instanced  a  case,  the  pressure  of  the  gumma  upon  the  posterior 
roots  of  the  nerves,  where  they  emerge  from  the  spinal  column.  I  spoke 
also  of  an  exostosis,  or  growth  from  a  bone;  the  lesion  may  be  an  aneur- 
ism bringing  pressure  upon  the  sympathetics;  or  it  may  be  some  kind  of 
a  tumor,  as  in  the  case  of  exophthalmic  goitre.  I  then  quoted  from 
Robinson  to  show  what  the  effect  of  such  lesions  might  be.  I  went 
further  to  show  that  the  result  might  be  more  serious  than  mere  stimu- 
lation or  inhibition  of  nerve-force,  showing  how  it  might  cause  actual 
degeneration  of  the  nerves  and  paralysis  of  the  parts  supplied.  I  showed 
you  how  such  degeneration  might  be  accomplished  by  the  traumatic  ac- 
tion of  contraction  of  muscles.  That  although  the  Osteopath  was 
not  able  in  every  case  to  remove  these  lesions,  he  may  prevent  their  for- 
mation, or  he  may  foe  able  to  recognize  the  presence  of  such  lesions  and 
send  the  patient  to  a  surgeon  if  the  case  required  surgical  interference, 
without  himself  bothering  with  them. 

I.  GENERAL  CONSIDERATIONS.— There  is  a  question  that  some- 
times arises  in  the  mind  of  the  Osteopath  as  to  what  the  effect  of  STIMU- 
LATION OR  INHIBITION  will  be  upon  parts  which  he  is  not  attempting  to 
affect,  but  which  are  connected  directly  or  indirectly  with  the  parts  on 
which  he  is  working.  In  other  words,  will  he  thus  stimulate  or  inhibit 
other  important  parts  of  nerve-force,  and  thus,  you  might  say,  set  up  a 
pathological  result,  and  his  treatment  result  in  certain  pathological  pro- 
cesses which  were  not  intended?  Every  once  in  a  while  a  patient  will 
say  to  you,  such  and  such  a  thing  happened  after  your  last  treatment, 
and  do  you  think  that  your  treatment  could  possibly  have  led  to  such 
a  trouble?  If  you  are  perfectly  sure  that  the  action  of  ycur  treatment 
upon  surrounding  parts  is  not  such  as  to  produce  pathological  results, 
you  will  often  be  able  to  answer  him  strongly  in  the  negative,  when 
otherwise  he  would  think  you  to  blame  for  something  that  happened. 
You  will  frequently  meet  cases  of  that  kind.  I  have  had  a  number  of 
such  questions  asked  me.  When  considering  probability,  remember 


96  GENERAL   CONSIDERATIONS. 

that  the  tendency  is  always  toward  the  normal,  and  that  helps  you 
much,  unexpectedly  as  well  as  expectedly  sometimes,  not  only  where 
you  remove  a  lesion  and  depend  upon  nature  to  tend  toward  the  normal 
to  restore  things  as  they  should  be,  but  the  manipulation  that  you  make 
upon  an  affected  part  tends  to  restore  that  part  to  normal,  while  a 
manipulation  that  you  make  upon  the  parts  associated  does  not  tend 
to  the  abnormal  of  those  associated  parts  at  all,  but  the  effect  upon 
them  is  simply  what  might  be  compared  to  the  effect  of  exercise.  So 
you  need  not  be  afraid  of  producing  pathological  results  in  that  way. 
For  instance,  we  have  to  treat  the  pneumogastric  in  a  case  where  the 
liver  is  not  acting  properly,  and  the  intestines  seem  to  be  lacking  in 
stimulating  force.  Part  of  .our  treatment  in  such  a  case  would  be  di- 
rected to  the  pneumogastrice  nerve,  since  it  has  to  do  with  these  viscera. 
Now,  the  question  is,  whether  by  stimulating,  or  inhibiting,  or  treating 
those  nerves  you  would  also  have  an  effect  upon  the  lungs  and  heart, 
which  are  supplied  by  the  pneumogastric  nerves,  an  effect  which  would 
be  bad.  Such  has  not  been  the  experience  at  all,  and  you  are  not  in 
danger,  in  treating  the  pneumogastric  in  such  a  case,  of  having  a  bad 
effect  upon  the  heart  and  lungs,  supposing  them  to  be  normal,  because 
your  treatment  tends  to  restore  the  abnormal  intestine  and  liver  to  the 
normal,  while  it  tends  simply  to  have  the  effect  of  exercise  upon  the  other 
parts.  Again,  yeu  might  have  a  stomach  case  in  which  the  splanchnics 
were  involved,  and  one  who  was  very  careful  over  questions  of  theory 
might  want  to  know  whether  treating  those  nerves  world  have  a  bad 
effect  upon  the  kidneys.  Experience  shows  that  such  would  not  be 
the  case.  Or,  for  instance' in  the  case  of  eye  trouble,  you  frequently  find 
that  the  terminal  branches  of  the  fifth  nerve,  emerging  from  the  supra- 
orbital  foramina,  are  very  tender  to  the  touch,  probably  on  account  of 
a  secondary  lesion  there,  abnormal  impulses  coming  from  that  nerve 
terminal  causing  the  tissues  about  the  foramina  to  contract  and  impinge 
upon  the  nerve,  thus  keeping  it  tender.  That  may  be  the  cause  of  it. 
Now  in  treating  there  you  simply  remove  the  contraction  abo'Jt  the 
parts,  you  stimulate  the  blood  vessel  and  the  nerve,  and  remove  the 
soreness.  You  would  not  be  afraid  of  interfering  with  the  nutrition  of 
the  eye,  which  is  innervated  by  the  fifth  nerve. 

This  will  serve  practically  to  explain  the  effects  obtained  by  those 
who  are  not  entitled  to  the  right  to  practice  Osteopathy,  certain  of 
those  who  have  seen  the  pecuniary  benefits  of  Osteopathy  and  gone  out 
without  proper  equipment,  and  have  become  what  Dr.  Still  calls  ''en- 
gine wipers,"  and  I  presume  others  who  have  had  better  opportunities 
may  work  in  the  same  way.  That  is,  they  work  all  over  the  patient, 
and  work  pretty  near  half  an  hour,  so  the  patient  will  think  he  has 
had  a  good  treatment,  so  that  if  there  is  a  place  to  be  treated  he  will  be 


WORKING    AGAINST   THE   RESISTANCE.  97 

sure  to  happen  upon  it.  That  is  the  way  the  Osteopathic  quack  works 
in  most  instances,  taking  into  consideration  that  the  effect  is  toward 
the  normal,  he  gives  a  stimulating  treatment  all  over  the  body,  and 
if  he  strikes  a  few  lesions  they  may  be  helped,  as  the  tendency  is  toward 
the  normal.  That  will  explain  how  he  happens  to  get  results  in  some 
cases.  Our  work  is  to  remove  the  lesion,  and  not  to  be  afraid  that  we 
disturb  the  normal  conditions. 

Further,  concerning  work  upon  abnormal  parts,  it  is  considered  as  a 
principle  in  our  practice  that  we  should  WORK  AGAINST  THE  RESISTANCE  WE 
MEET.  That  is  a  little  hard  to  explain,  and  it  is  not  a  principle  which  will 
apply  as  generally  as  some  others.  Move  the  part  in  the  direction  in 
which  you  will  cause  the  unnatural  tension  to  appear.  Because  if  by 
moving  the  part  in  a  certain  direction,  as  for  instance,  flexing  the  limb, 
you  find  that  there  is  an  unnatural  tension  opposing  the  normal  move- 
ment, you  then  see  you  have  a  lesion  with  which  you  are  dealing,  and 
in  working  against  the  unnatural  tension  you  are  working  against  the 
lesion,  at  least  in  some  cases.  This,  then,  becomes  a  method  of  how  to 
work  to  remove  certain  lesions.  Dr.  Harry  Still  says  he  always  "springs 
the  part,"  as  he  expresses  it,  in  the  direction  to  cause  the  most  pain. 
Frequently  you  will  find  that  the  manipulation  that  you  put  upon  a  part 
will  be  diagnostic  in  part,  and  that  it  will  often  reveal  to  you  ceratin 
lesions  of  the  kind  I  have  described.  Remember,  that  in  such  cases 
your  cue  is  the  pain  that  you  find.  For  instance,  I  might  find  a  contrac- 
tion in  the  pyriformis  muscle  in  case  of  sciatica.  The  cause  frequently 
of  sciatica,  from  our  standpoint,  is  a  contraction  of  this  pyriformis  mus- 
cle in  such  a  way  as  to  impinge  upon  the  sciatic  nerve,  which  runs  un- 
der it.  So  that  you  will  then  have  an  abnormal  tendency  to  external 
rotation  of  the  head  of  the  femur,  and  the  movement  that  we  adopt  is 
of  such  a  nature  as  to  stretch  the  pyriformis  mus:le.  The  same  thing 
is  seen  in  stretching  the  ligamentum  nuchse,  or  the  stretching  of  the 
sterno-mastoid  muscle.  I  have  seen  cases  in  which  that  muscle  was 
stiffened  and  contracted,  in  wry  neck,  and  the  treatment  was  to  stretch 
the  muscle.  This  will  illustrate  what  I  mean  when  I  say  to  work 
against  the  resistance  which  you  will  find,  and  that  that  is  a  cue  to  the 
lesion  itself.  That  may  not  be  a  primary  lesion,  it  may  be  a  secondary 
lesion,  as  in  the  case  of  the  sterno-mastoid,  the  primary  lesion  may  be 
something  affecting  the  spinal  accessory  which  innervates  that  muscle, 
but  at  any  rate  it  has  set  up  a  certain  trouble  which  must  be  corrected. 
That  is  not,  as  I  said,  a  general  principle;  you  cannot  apply  it  every- 
where; it  applies  especially  to  parts  which  may  contract  and  thus  form 
obstructions.  Do  not  be  too  eager  in  carrying  out  this  idea,  because 
you  may  irritate  the  parts. 

In  the  removal  of  lesions  the  question  of  STIMULATION  OR  OF  INHIBI- 


98  STIMULATION   AND   INHIBITION. 

TION  becomes  secondary,  since  the  lesion  being  removed.  Nature  tends  to 
the  normal.     Nevertheless,  there  come  times  in  our  practice  when  we 
must  either  stimulate  or  inhibit  according  to  the  rules  laid  down.     As, 
for  instance,  after  we 'have  removed  the  lesion  and  we  have  still  to  treat 
the  parts  to  strengthen  them,  the  question  arises  once  more,  what  shall 
we  do  in  this  case,  stimulate  or  inhibit?     Our  work  is  not  entirely  con- 
fined to  the  removal  of  lesions.     Sometimes  the  lesion  is  not  apparent, 
and   we   hav£  to  go  to   work  at   the  innervation   of  the  parts  and  get 
the  results  that  we  desire,  either  by  stimulation  or  by  inhibition.     The 
disease  may  be  of  such  a  nature  that  this  will  be  the  rational  metnod 
of  treatment.      Not   that   we   should   not   look   for   lesions    always,    but 
sometimes  we  have  to  work  directly  upon  the  nerves.     For  instance,  in 
diarrhoea  or  flux,  their  abnormality  must  be  of  nerve  force,  it  frequently 
happens  that  we  simply  have  to  treat  that  case  by  strongly  holding  the 
spine;  that  is,  inhibiting  the  sympathetic  nerves,  even  though  we  may 
not  at  that  time  correct  some  lesion  in  the  spine.     I  frequently  inhibit 
strongly  all  along  the  lumbar  region,  and  I  certainly  did  nothing  there 
but  inhibit  nerve  action.     In  obstetrics  the  parturition  center  is  stimu- 
lated at  certain  times  to  cause  the  contraction  of  the  circular  fibres  of 
the  uterus;  we  are  not  removing  a  lesion  in  that  case,  we  are  stifnulting 
to  bring  about  the  desired  end,  and  are  working  upon  the  nerves  which 
control  those  muscles.     In  some  headaches  we  cannot  find  any  particu- 
lar lesion;  we  very  frequently  go  to  the  sub-oecipitals  and  inhibit  them — 
the  sub  and  great  occipitals.     In  the  case  of  epistaxis  we  must  stimu- 
late in  the  neck;  or  in  the  case  of  hiccoughs,  which  is  a  very  good  exam- 
ple, we  often  do  nothing  but  inhibit  the  phrenic  nerve  by  pressure.    The 
point  is  well  taken,  that  we  must  sometime  stimulate  or  inhibit  with- 
out removing  lesions,  either  after  removal  of  lesions,  or  in  the  absence 
of  discoverable  lesions.     That  then  brings  up  the  point  that  there  must 
be  some  different  movement  which  we-  employ  to  stimulate  or  inhibit. 
The  difference  in  stimulation  and  inhibition  is  well  illustrated  by  a  sim- 
ple phenomenon — a  very  slight  touch  over  different  parts  of  the  body 
will  cause  a  tickling  sensation,  which  may  become  almost  unbearable: 
whereas  a  firm  pressure  at  the  same  place  removes  the  conductivity  of 
the  nerves,  or  inhibits.     The  other-  was  a  stimulation.     In   general  the 
movement  used  to  inhibit  is  a  holding  or  pressing  motion.     I  will  show 
you  that  later;  a  holding  or  pressing  motion,  having  as  its  end  in  view  the 
idea  of  quieting  the  excitability  of  the  nerve,  that  is,  the  lessening  of  its 
conductivity,   which  is  done  by   pressure.     We   have  seen  that  to  be  a 
fact  according  to  the  authorities.       Thus,  in  pressure  upon  the  phrenic 
nerve,  we  quieled  the  spasm  of  the  hiccough. 

In  general,   alteration   of  pressure  and  a   relaxation   of  pressure,   is 
used  to  stimulate,  the  idea  being  to  excite,   to  titillate.     This  is  com- 


STIMULATION    AND    INHIBITION.  99 

parable  to  the  "making  and  breaking''  of  an  electric  current.  We  use 
alternate  pressure  and  relaxation,  and  the  idea  is  to  in  that  way  arouse 
nerve  force.  For  instance,  in  a  case  of  nose  bleeding,  we  have  to  rub 
the  superior  cervical  ganglion,  and  thus  stimulate  the  toniciiy  of  the 
blood  vessels.  In  stimulating  we  work  frequqently  along  the  spine, 
described  as  working  hard  and  fast,  making  and  breaking.  We  keep 
working  in  that  way.  We  do  not  adopt  the  pressing  motion,  what 
we  use  in  a  quick,  stimulating  motion.  That  is  the  Osteopathic  view 
of  how  we  stimulate  or  inhibit.  That  is  the  technique  of  manipulation. 
Perhaps  I  do  not  fully  agree  with  all  the  physiologists  say  on  the  sub- 
ject of  stimulation  or  inhibition,  but  1  think  I  have  shown  that  we  have 
a  pretty  good  allowance  of  authority,  from  quotations  made,  and  that  is 
the  way  we  get  results.  This,  then,  would  naturally  bring  us  to  consider 
the  question  of  the  degree  of  force  that  we  should  use.  It  is  certain 
that  you  can  stimulate  so  assiduously  that  you  can  get  the  opposite  re- 
suit,  and  finally  inhibit  instead  of  stimulate.  The  secret  of  it  is  that 
stimulation  must  amount  to  irritation,  which  if  performed  too  frequently 
or  too  hard  will,  after  it  has  run  its  course,  result  in  the  nerve  refusing 
to  respond  to  the  usual  stimulus,  and  finally  to  respond  to  any  stimulus 
if  the  irritation  is  carried  far  enough.  So  that  stimulation  may  become 
irritation,  and  finally  inhibition. 

You  must  remember  in  treating  a  patient  to  adapt  the  DEGREE  OF  FORCE 
to  the  end  in  view.  This  refers  not  only  to  the  treating  of  a  case,  how 
hard  to  treat  at  the  time,  but  the  treating  of  a  case  too  often.  A  great 
many  cases  want  to  be  treated  too  often.  A  patient  comes  into  your 
office,  and  you  tell  him,  "I  want  to  see  you  not  more  than  once  a  week, 
in  your  case  I  can  do  you  as  much  good  in  treating  you  once  a  week 
as  I  could  treating  you  three  times  a  week  or  every  day."  That  is  a 
fact,  but  the  patient  wants  to  get  all  he  can  for  his  money;  he  says,  "You 
are  charging  me  twenty-five  dollars  a  month,  and  I  think  I  ought  to 
get  more  than  four  or  five  treatments;  that  makes  it  come  pretty  high, 
and  I  would  like  at  least  two  treatments  a  week."  And  it  is  almost  im- 
possible to  prevent  treating  too  frequently,  but  when  you  do  of  course 
you  are  in  danger  of  irritating.  As  I  say,  you  must  explain  to  the 
patient  that  by  treating  so  often  you  irritate  these  nerves  and  struc- 
tures and  _thus  keep  up  an  abnormal  condition  instead  of  removing  it. 
You  might  also  say  that  it  is  not  you  who  cures,  but  Nature;  you  sim- 
ply aim  to  assist  her.  Now,  if  you  should  treat  so  often,  tell  him  you 
do  not  give  Nature  time  enough  between  times  to  work,  and  that  you  do 
riot  think  it  best.  You  have  to  learn  the  arguments  that  apply  to  such 
cases,  as  you  will  meet  them  frequently.  When  you  say  to  Nature  that 
you  will  aid  her  so  much  that  she  does  not  have  to  work  at  all,  she  finally 
gets  tired  of  the  effort,  "lays  off,"  and  lets  you  do  what  you' can.  We 


100  GENERAL   CONSIDERATIONS. 

had  a  case  in  Chicago  of  neuralgia  of  the  fifth  nerve  which  was  treated 
once,  and  it  disappeared  for  quite  a  long  time.  It  finally  returned  and  was 
quite  a  severe  case,  as  hard  a  case  to  treat  as  any  that  I  had  ever  seen. 
We  tried  all  sorts  of  treatment  and  finally  got  to  treating  if  pretty  nearly 
every  day,  but  it  did  not  do  much  better.  Finally  we  told  the  gentleman 
not  to  come  back  to  us  inside  of  a  week  or  two  weeks.  We  had  by 
this  time  quit  taking  his  money,  but  were  trying  to  do  what  we  could 
for  him,  so  he  was  willing  to  do  that.  The  result  was  improvement.  We 
had  simply  stimulated  until  we  had  irritated  and  kept  up  the  abnor- 
mality. 

Then,  again,  some  lesions  must  be  removed  only  gradually.  If  you 
go  to  work  and  remove  the  lesion  instantly,  you  do  not  give  Nature 
time  to  accommodate  herself  to  the  changed  conditions.  Nature  has 
been  for  years  at  work  trying  to  adapt  herself  to  the  unnatural  condition 
of  things,  and  she  has  done  so  to  a  greater  or  less  extent  finally,  and 
now  you,  as  an  Osteopath,  try  to  change  all  that  in  a  second's  time.  It 
can  rarely  be  dene.  I  have  known  of  some  cases  where  a  very  quick 
change  could  be  made,  but  it  is  not  a  very  common  occurrence.  I  have 
heard  Dr.  Harry  Still  state  that  he  had  set  a  hip  too  soon  and  he  had 
great  difficulty  with  it  until  he  had  gotten  it  out  again,  because  the  mus- 
cles were  all  so  contracted  by  being  adapted  to  the  abnormal  conditions. 
They  would  not  relax  as  they  would  normally  have  done,  when  the  hip 
was  in  place,  and  he  had  great  trouble  to  get  it  out  again.  The  lesion 
should  not  be  reduced  too  soon.  In  a  case  of  asthma  Dr.  Still  says  we 
should  not  treat  oftener  than  once  in  ten  days  or  two  weeks,  because  by 
frequent  treatment  we  keep  up  the  irritation. 

I  wish  as  soon  as  possible  hereafter  to  take  up  certain  centers  and  the 
consideration  of  the  sympathetic  system  that  I  left  aside  after  the  first  few 
lectures,  as  it  is  an  important  subject-.  There  are  certain  things  which  I 
wish  to  bring  to  your  attention  to-day  in  regard  to  them.  Remember 
that  stimulating  accelerator  fibers  accelerates  and  stimulating  inhibitory 
fibers  inhibits.  For  instance,  if  you  were  to  treat  the  heart  and  wish  to  stim- 
ulate its  action,  you  will  recollect  that  there  are  two  sets  of  nerves  inner- 
vating the  heart;  one  the  sympathetics,  and  the  other  from  the  pneumo- 
gastncs.  Ihe  sympathetic  keeps  the  heart  running  and  tends  to  run  it 
too  fast,  while  the  inhibitory  influence  of  the  pneumogastric  is  to  bring 
about  an  equilibrium  between  the  forces,  and  keep  it  running  just  right. 
If  it  is  not  running  just  right,  not  fast  enough,  you  will  need  to  stimu- 
late it,  in  which  case  you  would  stimulate  the  sympathetic  supply  to  the 
heart  through  the  upper  dorsal  and  the  cervical  ganglia,  and  you  would 
inhibit  the  pneumogastric,  so  as  to  remove  the  inhibitory  influence.  You. 
would  thus,  according  to  the  theory,  get  a  stimulating  effect  upon  the 
heart.  If  you  wish  to  quiet  the  heart's  action  you  would  adopt  just  the 


GENERAL    CON  SI  DERATIONS.  101 

'  *    ;  ._  i_   "_    ;  i    ~" 

opposite  plan  of  treatment.  That  will  illustrate  the  fact  that  stimulating  a 
nerve  stimulates  it  to  its  action  whether  its  action  be  that  of  an  accelera- 
tor or  an  inhibitor.  Stimulating  vaso-dilators  dilates.  Stimulating  vaso- 
constrictors constricts.  This  is  very  simple  and  perhaps  it  seems  un- 
necessary to  call  it  to  your  attention  except  in  the  connection  it  has  with 
these  other  things. 

There  are  certain  things  to  remember  in  relation  to  the  vaso-motor 
system,  and  which  though  hard  to  explain  are  of  a  great  deal  of  importance 
to  the  Osteopath.  There  are  certain  things  concerning  the  centers  and 
the  fibers.  It  is  said  that  vaso-motor  fibres  are  present  in  some  cranial 
nerves,  for  instance,  the  chorda  tympani  of  the  facial  nerve.  The  chorda 
tympani  is  the  vaso-dilator  of  the  submaxillary  gland.  The  general  vaso- 
motor  center  is  in  the  medulla.  It  is  said  by  Howell's  Text  Book,  how- 
ever, that  that  center  is  a  constricting  center,  from  which  a  continual  con- 
strictor impulse  goes  to  all  parts  of  the  body,  preserving  the  proper  ton- 
icity  of  the  blood  vessels,  but  he  says  it  is  not  proven  that  there  is  any 
vaso-dilator  center  in  the  medulla.  Simply  not  proven ;  there  may  be, 
however.  The  vaso-constrictor  fibers,  as  before  stated,  leave  the  spinal 
cord  from  the  second  dorsal  to  the  second  lumbar,  while  vaso-dilators  leave 
the  cord  all  the  way  along,  being  not  limited  to  certain  places. 

We  frequently  meet  with  the  terms  in  description  of  the  circulation,  in- 
crease of  blood  pressure,  and  so  on.  Remember  that  stimulating  vaso-con- 
strictors  constrict  the  blood  vessels,  and  thus  lessens  the  quantity  of 
blood  in  that  part,  but  it  increases  the  blcod  pressure.  On  the  other 
hand,  the  vaso-dilators  loosen  the  vessels  and  allow  more  blood  to  go  to 
the  part,  but  decrease  the  amount  of  blood  pressure.  I  thought  I  would 
call  that  to  your  attention  so  you  would  not  get  those  facts  confused. 

A  further  fact  that  you  must  take  into  consideration  is  that  some- 
times a  single  anatomical  nerve  will  contain  more  than  one  kind  of 
fibres,  vaso-dilator  and  vaso-constrictor  fibres.  That  is  true  in  the  case 
of  the  sciatic  nerve,  and  the  result  you  would  get  in  stimulating  the 
sciatic  nerve  would  be  an  average  result  between  vaso -dilator  power  and 
vaso-constrictor  power.  Again,  sometimes  stimulating  a  center  will  pro- 
duce vaso-dildtion.  and  sometimes  vaso-constriction.  You  might  have  a 
vaso-dilator  center  and  expect  it  always  to  produce  vaso-dilation,  but 
according  to  Howell's  Text  Book  the  center  is  sometimes  changed  in 
condition',  and  you  get  the  opposite  effect  by  its  stimulation.  Vase-con- 
strictors are  less  easily  excited  than  vaso-dilators.  Vaso-constrictors 
degenerate  more  rapidly  when  injured.  The  maximum  effect  of  stimu- 
lation is  more  readily  reached  in  vaso-constrictors  than  in  vaso-dilators. 
Vaso-motor  nerves  are  axis  cylinders  of  sympathetic  nerve  cells.  The 
pilo-motor  and  secretory  fibers  we  shall  consider  later  when  speak- 
ing of  the  structures  in  wnich  they  terminate.  As  we  cannot  be  certain 


102  TREATMENT   OF   THE   KECK. 

i  i  ,  (A SO  ~"  1  c  L     nO    3  '..   .- fC  L 

of  all  these  things  we  hatre  ttf>  d«{pQnd  more  than  ever  upon  the  tendency 
toward  the  normal — we  cannot  always  work  to  get  a  set  vaso-motor  or 
vaso-dilator  effect. 

II.  TREATMENT  OF  THE  NECK.— (Continued.)— The  spinal 
accessory,  pneumogastric  and  glosso-pharyngeal  nerves  emerge  at  the 
jugular  foramen.  We  frequently  have  to  treat  them,  especially  the 
pneumogastric  and  the  spinal  accessory;  the  pneumogastric  perhaps  more 
often.  We  treat  them  in  various  ways.  We  can  reach  the  pneumogastric 
by  deep  pressure  over  the  exit  from  the  skull — deep  pressure  just  blow 
the  mastoid  process  will  affect  the  nerve.  Some  work  there.  Others 
work  on  the  pneumogastric  by  stimulating  all  along  the  anterior  border 
of  the  sterno-mastoid  muscle.  Thus  you  get  a  sort  of  massage  and  direct 
mechanical  pressure  upon  that  nerve,  and  no  doubt  affect  it  there.  An- 
other very  good  way  to  reach  these  three  nerves  is  through  the  superior 
cervical  ganglion.  That  is,  we  work  on  the  superior  cervical  ganglion 
to  affect  them.  We  may  affect  the  superior  ganglion  by  working  on  the 
sub  and  great  occipital  nerves.  That  is  rather  an  indirect  way,  but  it  is 
claimed  that  we  get  an  effect  upon  those  nerves  by  working  in  that 
place.  That  is  the  method  Dr.  Hildreth  uses  to  reach  those  nerves. 

There  are  various  ways  in  which  we  reach  the  phrenic  nerve,  one  way 
is  to  carefully  find  its  location  opposite  the  transverse  process  of  the 
third,  fourth  and  fifth  cervical  vertebrae,  and  impinge  back  upon  them, 
thus  pressing  the  nerve  against  the  transverse  process.  That  is  one  way. 
The  way  that  Dr.  Harry  Still  treats  the  phrenic  nerve  is  by  thrusting  the 
thumb  behind  the  clavicle  and  the  first  rib  above;  that  is,  thrusting  it 
above  the  clavicle,  behind  it  and  the  first  rib,  then  pushing  the  bent  arm 
and  hand  back  over  the  shoulder  in  this  way,  thrusting  the  thumb  in 
deeply  at  the  sternal  end  of  the  clavicle  and  holding  in  order  to  im- 
pinge upon  the  nerve  and  lessen  its  conductivity,  thus  inhibiting  the  ac- 
tion of  that  nerve.  It  is  sometimes  reached,  by  pressure  at  the  sternal 
end  of  the  clavicle.  You  can  either  press  in  the  fonticulus  gutturis, 
slightly  backward,  or  between  the  sternal  and  clavicular  ends  of  the 
origin  of  the  sterno-mastoid  muscle,  backward  and  inward,  to  impinge 
upon  the  nerve.  The  best  place  to  treat  it  is  the  best  place  that  your 
practice  tells  you  you  can  reach  it.  Different  ones  treat  in  different 
places,  and  it  also  depends  upon  the  patient,  as  to  how  thick  or  how  thin 
his  neck  is. 

Next  we  will  consider  the  treatment  of  the  STERNO  MASTOID  MUSCLE. 
We  can  get  a  direct  pressure  by  working  along  its  course.  It  is  very 
readily  worked  upon  in  this  way,  relaxing  it  and  drawing  it  toward  you 
without  rubbing  the  fingers  over  the  neck.  Another  way  is  to  follow 
the  obliquity  of  the  muscle  and  turn  the  head,  thus  stretching  the  muscle 
on  the  same  side.  Remember  that,  on  account  of  the  obliquity  of  the 


TREATMENT   OF   THE   NECK.  103 

splenius  capitis  and  the  superior  and  inferior  oblique  muscles  behind, 
you  will  at  the  same  time  stretch  them,  and  I  find  that  a  very  good  plan 
in  giving  the  neck  a  general  treatment,  as  I  will  show  you  later.  Of 
course  you  may  have  some  trouble  with  the  spinal  accessory  nerves 
causing  a  stiffening  of  the  sterno-mastoid,  in  which  case  you  must  give 
it  attention. 

Now  as  to  treating  the  neck  proper,  or  the  back  of  the  neck.  The  first 
thing  is  to  loosen  all  of  the  muscles.  In  giving  trm  treatment  I  always 
use  the  flat  of  my  hands,  lay  them  directly  on  the  neck,  and  have  thus 
a  broad  hold  and  do  not  run  any  risk  of  hurting  by  presfure  with  the 
tips  of  the  fingers.  I  usually  go  to  work  in  this  way  and  work  straight 
backward,  thus  loosing  all  of  the  muscles,  giving  a  certain  twist  or  turn 
as  I  work.  You  will  be  able  to  recognize  by  the  sense  of  touch  when 
you  have  relaxed  everything.  It  is  also  good  to  relax  the  muscles  by 
working  from  the  side.  Remember  above  the  third  cervical  to 
work  upward,  and  below  it  downward.  I  relax  all  the  muscles  that  are 
hard.  Then  when  you  have  them  thoroughly  relaxed,  it  is  a  good  idea 
to  still  further  relax  the  deeper  structures  by  a  straight  pull.  I  hold  be- 
neath the  jaw  and  occipital  protuberance  and  draw  the  patient  gradually 
toward  me,  that  stretches  the  neck.  I  have  warned  you  not  to  turn  it 
while  stretching  it  in  that  way.  I  then  turn  the  neck  strongly  from  side 
to  side  in  this  general  treatment-  of  the  neck,  loosening  all  the  deeper 
structures,  stimulating  all  the  parts  about  the  vertebra?,  and  loosening 
the  ligaments.  Then  before  finishing  the  neck  I  usually  stretch  the  liga- 
mentum  nuchse  and  also  the  other  ligaments  about  the  vertebne.  as  I 
have  already  shown  you  how  to  do. 

*It  is  an  important  question  how  to  treat  the  CERVICAL  GANGLIA  OF  THE 
SYMPATHETIC.  As  I  said,  we  usually  affect  them  by  treating  the  sub  and 
great  occipital  nerves,  that  is,  by  pressure  in  the  sub-occipital  fossa?.  The 
way  in  which  we  inhibit  their  action  is  by  holding  deeply  in  those  fossa? 
and  then  turning  the  head  from  side  to  side,  rotating  it  as  you  go;  and 
you  thus  work  deep  into  the  parts  trying  to  get  direct  pressure  upon 
the  sub  and  great  occipital  nerves.  Through  their  connection  with 
the  cervical  sympathetic  you  influence  it.  Some  operators  treat  that 
way  almost  entirely  and  results  would  indicate  that  they  were  accom- 
plishing what  they  were  attempting.  You  must  riot  be  in  a  hurry,  but 
turn  the  head  slowly  from  side  to  side  and  hold  firmly.  Some  treat  the 
first  ganglion  directly  by  pressure  opposite  the  second  and  third  cervical 
vertebrae,  a  little  in  front  and  backward,  thus  impigning  it  against  the 
hard  parts  of  the  spine  beneath.  In  the  same  way  you  can  reach  the  sec- 
ond one,  the  third  I  think  you  cannot  reach  from  the  front  of  the  neck, 

*See  appendix  7. 


lOi  TREATMENT   OF   THE   NECK. 

that  must  be   reached   indirectly  through   sympathetic  connections  with 
the  spinal  nerves  behind. 

To   stimulate  these   ganglia,  pressure  and  relaxation   are  employed. 

In  treating  AN  ATLAS  we  use  a  combination  of  motions  already  shown, 
that  is,  a  thorough  lessening  of  all  the  parts.  Then  by  traction,  rotation 
and  pressure  upon  the  prominent  part  you  can  work  it  back  into  its 
place.  Of  course  it  takes  time,  and  frequently  has  to  be  done  very 
slowly.  That  same  method  can  be  pursued  for  all  the  cervical  vertebrae. 
Tt  is  something  you  will  have  to  learn  by  experience.  Another  way  to 
set  the  atlas  is  with  the  patient  sitting  on  the  chair.  This  is  a  move 
that  Dr.  Still  showed  us  not  a  great  while  ago.  He  puts  his  knee  under 
the  jaw  and  rotates  the  head  in  a  direction  to  throw  out  prominently  the 
part  which  is  out  of  place,  and  then  placing  his  thumb  or  fingers  upon 
that  part,  -rotates  the  head  back  again,  the  idea  being  extension  and 
flexion  in  such  a  way  as  to  disengage  the  articular  processes  and  allow  the 
part  to  resume  its  normal  position. 

In  order  to  work  out  the  sore  places  that  you  will  frequently  find  in 
the  sub-occipital  fossae  and  just  beneath  the  occipital  protuberance  yovt 
should  relax  all  the  parts,  both  the  ligaments  and  the  muscles. 

I  will  now  show  you  how  I  usually  work  upon  the  neck;  I  will  work 
just  as  if  I  had  come  in  and  found  this  neck  in  a  generally  bad  condi- 
tion and  wish  to  relieve  it.  The  treatment  of  the  neck  is  a  very  import- 
ant thing.  You  need  not  be  afraid  of  getting  down  close  to  the  shoulder 
and  stretching  all  of  those  muscles.  It  is  a  good  thing  to  get  the  head 
against  you  and  push  downward  as  you  turn,  you  can  thus  sometimes  re- 
lax the  parts  and  start  the  vertebrae  toward  their  normal  position.  It 
takes  considerable  time  to  treat  a  neck  thoroughly  and  well.  One  thing 
which  I  did  not  mention  is  that  you  can  stretch  the  scaleni  muscles  very 
readily  by  holding  the  head  straight  and  without  turning  it,  pushing  ft  di- 
rectly to  the  side.  If  it  is  a  case  of  headache,  I  save  the  inhibiting  move- 
ment until  the  last,  and  by  holding  firmly  in  the  superior  cervical  region, 
particularly  at  the  sub-occipital  foss.e.  I  get  good  results. 

Q.  You  were  speaking  of  stretching  the  pyriformis  muscle.  Please 
show  us  how  that  was  done. 

A.  That  muscle  is  an  external  rotator,  and  an  extreme  internal  ro- 
tation will  be  all  that  is  necessary  to  stretch  it.  Work  opposite  to  the  de- 
fect. 


LECTURE   XVI. 

At  the  last  lecture  I  invited  your  attention  first  to  the  general  princi- 
ple of  oijr  treatment,  that  manipulation  always  tends  to  restore  parts  to 
normal,  following  it  out  along  the  idea  that  therefore  should  we  manipu- 


THR    PHRENIC   NERVE.  105 

late  a  part  which  was  not  diseased,  we  need  not  be  in  any  fear  that  we 
would  make  it  abnormal,  because  the  tendency  would  be  to  excite  it  in 
the  way  that  normal  exercise  would  excite  it.  But  we  by  manipulation  of 
the  abnormal,  on  account  of  this  tendency,  result  in  tending  to  the 
normal  and  in  helping  to  cure  the  disease.  This  is  a  partial  explanation 
of  why  our  friends,  the  "engine  wipers,"  who  work  over  nearly  all  the 
body,  and  work  for  nearly  an  hour,  can  get  some  results,  when  they 
are  not  Osteopaths  at  all.  Another  point  was  that  you  should  take  the 
pain  as  the  cue,  and  move  the  part  or  stretch  it  in  the  direction  in  which 
you  meet  the  resistance,  since  thereby  you  work  against  the  lesion.  1 
explained  about  how  general  that  should  be,  that  you  should  not  irri- 
tate in  so  doing.  Although  the  question  oi  stimulation  and  inhibition  is 
a  secondary  one  to  removal  of  lesion,  we  sometimes  stimulate  or  inhibit 
irrespective  of  lesion  or  after  removal  of  it.  In  general,  we  inhibit  by 
pressure,  by  holding;  we  stimulate  by  brisk  work  similar  to  making  and 
breaking  of  an  electric  current,  and  there  was  a  question  of  dtgree  of 
force;  you  might  stimulate  hard  enough  to  inhibit.  There  were  certain 
elementary  points  concerning  nerves  winch  I  thougnt  would  be  profitable 
to  bring  10  your  attention;  that  stimulating  an  accelerator  nerve  accel- 
erates, stimulating  a  vaso-dilator  dilates,  stimulating  a  vaso-constrictor 
constricts.  I  also  called  certain  centers  to  your  mind,  the  fact  that  the 
cenier  in  the  medulla  is  a  vaso-constrictor  center,  and  that  a  vaso-dilator 
center  has  not  been  found  to  exist,  although  it  may  be  there. 

I.  THE  PHRENIC  NERVE.  What  I  wish  to-day  to  do  is  to  notice 
more  particularly  something  concerning  the  phrenic  nerve.  You  all  know 
its  location  and  treatment;  how  it  arises  from  the  third,  fourth  and  fifth 
cervical  nerves,  especially  the  lourth,  having  some  branches  from  the 
tnira  and  a  recurrent  branch  from  the  fifth;  that  it  is  reached  in  different 
ways,  being  impinged  against  the  transverse  processes  of  the  vertebrae,  or 
being  reached  at  the  fonticulus  gutturis,  or  behind  the  first  rib  and  the 
ciavicle;  that  it  is  important  to  us,  but  has  been  so  mainly  as  a  means 
of  stopping  hiccoughs.  However,  I  think  it  should  be  oi  greater  im- 
portance to  the  Osteopath,  and  while  J  have  not  heard  these  matters 
brougm  out.  mat  i  am  going  to  bring  out  this  atternoon,  yet  I  mention 
them  in  the  way  of  suggestion  for  further  worn.  Ptrhaps  I  do  not  know 
all  that  others  have  done  with  the  phrenic  nerve;  tuese  points  are  more 
in  the  manner  of  theories,  but  if  what  I  have  already  said  is  true,  certainly 
the  phrenic  nerve  has  considerable  importance  to  us  as  an  adjuvant  to 
our  work. 

The  phrenic  nerve  has  important  connections  with  the  sympathetic 
system.  Gray  says  that  the  phrenic  nerve  supplies  the  pericardium  and 
the  pleura  by  filaments;  that  in  the  thoracic  cavity  a  filament  is  sent  from 
the  sympathetic  to  join  the  phrenic  nerve;  and  that  there  are  also  branches 


106  THE    PHRENIC   NERVE   AND    ITS   SYMPATHETIC    CONNECTIONS. 

to  the  peritoneum.  From  the  right  nerve  there  are  branches  to  the 
phrenic  ganglion,  which  is  situated  just  below  the  diaphragm,  the  termin- 
als, of  course,  perforating  the  diaphragm  to  reach  this  phrenic  or  dia- 
phragmatic ganglion  of  the  sympathetic.  This  ganglion  of  the  sympa- 
thetic is  connected  with  the  solar  plexus.  This  ganglion  sends  branches 
to  the  hepatic  plexus,  and  also  some  filaments  to  the  inferior  vena-cava. 
Its  function  as  a  spinal  nerve  is  to  supply  the  muscle  of  the  diaphragm. 
From  the  left  nerve  branches  go  to  join  the  solar  plexus,  but  there  is  no 
ganglion  formed. 

Quain  substantiates  those  points,  and  says  further  that  branches  reach 
the  phrenic  in  the  neck  from  the  middle  or  the  lower  sympathetic  ganglia, 
some  branches  going  to  the  pericardium,  and  that  from  the  right  nerve 
were  branches  going  to  the  inferior  vena-cava,  both  above  and  below 
the  diaphragm,  and  that  branches  also  go  to  the  right  auricle  of  the 
heart.  Pansini,  according  to  Quain,  has  found  in  animals  that  the 
phrenic  plexus  of  the  diaphragm  is  participated  in  by  the  lower  three 
intercostal  nerves.  You  will  see  that  the  purpose  is  to  associate  the 
muscles  of  respiration,  the  abdominals,  intercostals  and  the  diaphragm 
itself.  Quain  states  further  that  the  phrenic  may  have  a  branch  from 
the  hypoglossal  nerve-  and  from  the  fifth  cervical  nerve.  Such  are  the 
facts  in  relation  to  the  phrenic  and  its  distribution.  When  we  examine 
those  facts  in  the  light  of  Osteopathy,  it  seems  certain  that  we  find 
the  phrenic  significant  to  us  in  more  ways  than  one.  You  see  from 
what  I  have  said  that  the  phrenic  is  connected  with  the  sympathetics ; 
first  with  the  middle  or  lower  sympathetics  in  the  neck;  next  that  it  re- 
ceives a  filament  from  the  sympathetic  in  the  chest ;  next,  that  it  perforates 
the  diaphragm  to  join  the  nerves  of  visceral  life,  those  on  the  right  run- 
ning from  the  diaphragmatic  ganglion,  those  on  the  left  joining  without 
the  intervention  of  a  ganglion.  You  notice  further  that  it  has  a  connec- 
tion with  a  cranial  nerve — the  hypoglossal ;  that  it  has  branches  connected 
with  the  brachial  plexus,  that  is,  from  the  fifth  cervical ;  and  that  it  may 
perhaps  join  with  the  lower  three  intercostals,  but  I  do  not  know  that  that 
has  ever  been  shown  to  be  true  in  man.  The  conclusion  is  obvious,  then, 
from  what  we  know  of  the  connection  of  nerves  in  different  parts  of  the 
body,  both  sympathetic  and  otherwise,  that  if  any  of  these  sympathetic, 
spinal  or  cerebral  nerves  were  diseased,  the  disease  might  conceivably 
be  extended  to  the  phrenic  and  effect  it,  and  that  we  might  have  phrenic 
symptoms  arising  from  these  other  troubles.  The  reverse,  of  course,  is 
true,  and  that  any  of  these  structures  which  are  supplied  by  the  sympa- 
thetics or  these  other  nerves,  may  reflexly  be  affected  by  the  phrenic 
nerve  when  diseased.  You  have  seen  that  it  supplies  the  pericardium, 
pleura  and  peritoneum, .  that  it  supplies  one  of  the  great  blood  vessels, 
the  inferior  vena-cava,  and  sends  branches  to  the  right  auricle  of  the 


THE  PHRENIC  NERVE.   WORK  UPON  NERVE  TERMINALS.        107 

heart,  and  there  is  no  reason,  according  to  our  theory,  why  disease  in  any 
of  these  situations  might  not  affect  the  phrenic  nerve,  and  you  might 
have  symptoms  of  disease  in  the  phrenic  nerve.  So  that  our  theoretical 
rule  is  certainly  a  good  one,  for  it  will  work  both  ways,  either  affecting 
the  phrenic  nerve,  or  the  other  structures,  as  the  case  may  be.  The  im- 
portance of  this  to  us  lies  in  the  fact  that  it  would  be  an  adjuvant  in 
the  treatment  already  used.  It  is  one  more  path  by  which  we  can  influ- 
ence nerve  force.  We  have  certain  ways  of  reaching  the  abdominal  vis- 
.cera,  through  the  splanchnics  in  the  back;  we  might  have  a  case  that  we 
could  not  effect  in  that  region,  but  if  we  could  reach  the  trouble  through 
the  phrenic,  we  would  accomplish  the  desired  result.  As  I  have  said, 
these  facts  are  not  fully  demonstrated,  but  it  is  a  theory  which  I  leave 
for  your  consideration,  and  which  you  can  work  on  in  your  practice.  It 
comes  to  us  as  another  key  to  unlock  the  doors  of  sympathetic  life;  an- 
other way  in  which  we  can  work ;  another  tool  in  our  hands. 

I  wish  to  call  up  what  Dr.  Hilton  says  in  regard  to  the  phrenic  nerve; 
he  sets  out  very  clearly  why  it  is  that  it  perforates  the  diaphragm  and  is 
distributed  on  its  lower  surface  rather  than  upon  its  upper  surface.  He 
shows  that  were  it  distributed  to  the  upper  surface  the  nerves  would  then 
be  impinged  upon  by  the  lungs,  and  you  would  have  constant  interference 
with  nerve  force,  but  it  is  distributed  on  the  under  side  of  the  diaphragm, 
where  it  is  removed  from  the  tendency  of  pressure  of  parts  above,  and 
the  tendency  of  the  force  of  gravitation  is  to  draw  away  the  stomach,  liver 
and  spleen  from  the  under  surface  of  the  diaphragm,  so  that  there  can 
be  no  interference  with  the  plexus  situated  below  the  diaphragm.  Dana 
makes  use  of  this  tendency  of  gravitation  in  the  case  of  hiccoughs,  but 
in  a  somewhat  different  way.  He  states  that  it  has  a  very  effective  action 
in  hiccoughs.  He  places  the  patient  on  a  table  with  his  head  down  over 
the  edge  of  the  table,  that  would  allow  the  thorax  to  arch  up,  and  the 
action  of  gravitation  would  allow  the  heavy  viscera  to  impinge  upon  the 
under  surface  of  the  diaphragm,  and  it  would  in  that  way  be  helpful  in 
stopping  hiccoughs,  by  inhibiting  the  nerves  of  the  plexus.  Hilton  does 
not  explain  it  so.  It  may  be  that  the  stretching  of  the  thorax,  thus  ex- 
tending the  contracted  muscle,  would  by  its  extension  send  an  impulse 
back  over  the  nerve  and  quiet  the  spasm.  I  have  not  heard  it  explained 
why  the  drinking  of  cold  water  stops  hiccoughs,  but  there  may  be  an 
explanation  here  in  connection  with  the  sympathetics  ;  that  the  action  of 
the  cold  water  may  be  such  as  to  for  a  while  inhibit  the  action  of  the 
sympathetics,  sending  an  action  reflexly  back  to  the  phrenic  from  its 
sympathetic  connections,  and  thus  causing  the  spasm  of  the  hiccoughs  to 
be  released. 

So  in  our  work  upon  the  abdominal  viscera  we  may  avail  ourselves 
of  the  advantage  of  work  in  the  neck  on  the  phrenic.  Dana  states  that  he 


108  THE   PHRENIC   NERVE.      WORK    UPON   NERVE  TERMINALS. 

treats  diaphragmrtic  palsy  by  electricity  applied  to  the  neck.  He  says 
there  is  a  motor  area  in  the  neck  which  is  readily  affected  by  the  elec- 
tric current.  It  no  doubt  corresponds  with  the  work  we  do  when  we 
brirar  DTcsure  directly  upon  the  phrenic  nerve. 

I  wish  to  quote  from  Dr.  Jacobson  along  this  line  as  follows :  "An- 
other reason  for  the  phrenic  nerves  traversing  the  diaphragm,  and  break- 
ing up  into  branches  on  its  under  surface,  may  be  to  enable  them  to  come 
into  communication  with  the  sympathetic  or  visceral  nerves  of  the  ab- 
domen. From  this  communication  branches  are  given  to  the  hepatic  and . 
solar  plexuses,  and  the  inferior  vena  cava.  Everyone  knows  the  value  of 
active  exercise  when  certain  abdominal  viscera  are  torpid  in  the  perform- 
ance of  their  functions,  e.  g.,  in  constipation,  biliousness,  etc.  The  perfora- 
tion of  the  diaphragm  by  the  phrenic  and  its  communication  with  the 
abdominal  sympathetics  must  bring  the  brain  and  spinal  cord,  the  diaph- 
ragm and  abdominal  muscles,  so  important  in  active  respiration,  into  inti- 
mate association  with  the  subjacent  viscera."  So  says  Dr.  Jacobson. 
Hence,  we  see  that  we  can  go  farther,  and  say,  that  since  the  brain  and 
cord  are  thus  brought  into  connection  through  the  phrenic  with  the  sym- 
pathetics and  with  abdominal  sympathetic  life,  and  since  the  brain  must 
send  certain  impulses  along  those  nerves  and  thus  affect  abdominal  sympa- 
thetic nerve  life,  there  is  no  reason  why  the  reverse  may  not  be  true. 
Why  may  we  not  affect  the  brain  and  cord  by  working  back  from  the  sym- 
pathetics. and  more  particularly  when  there  is  a  lesion,  because  manipula- 
tion must  tend  toward  the  normal  ?  You  would  manipulate  the  phrenics : 
the  abnormalities  would  be  affected,  you  would  affect  the  phrenic,  and 
thus  be  more  likely  to  affect  other  nerves  which  have  under  control  that 
which  has  become  abnormal.  There  is  no  reason,  according  to  our  theory, 
why  we  would  not  tone  up  the  whole  mechanism  of  respiration,  especially 
the  muscular  respiration,  since  it  is  in  connection  with  the  phrenic  nerve 
and  with  the  abdominal  sympathetic. 

I  emphasize  once  more  what  I  have  said  frequently  before — that  work 
upon  nerve  terminals  will  affect  the  nerve  itself,  and  will  affect  the  center 
from  which  it  comes.  I  think  that  position  taken  by  Osteopaths  is  impreg- 
nable. I  wish  to  quote  from  Dr.  Hilton  in  a  case  of  pain  in  the  knee,  where 
.the  trouble  was  in  the  hip.  which  the  Osteopath  often  meets,  and  which 
shows  us  that  doctors  are  not  always  in  the  dark  in  their  diagnosis  of  these 
cases.  Dr.  Hilton  says:  "We  find  some  patients  with  hip-joint  disease 
suffering  from  pain  in  the  knee.  Now,  although  the  disease  does  not  lie 
there,  we  know  that  the  pain  can  be  relieved  by  a  belladonna  plaster,  or 
strong  hemlock  poultices,  or  fomentations  applied  over  the  knee-joint,  thus 
acting  upon  the  nerves  of  the  hip-joint  through  the  medium  of  those  which 
are  spread  over  the  knee-joint."  He  has  made  the  point  previously  that 
the  nerves  of  a  joint  supply  also  the  skin  over  the  joint  and  over  the  inser- 


THE  PHRENIC  NERVE.   WORK  UPON  NERVE  TERMINALS.        109 

tion  of  the  muscles  which  move  the  joint.  So  you  have  one  nerve  going  to 
a  joint,  to  its  muscles  and  to  the  skin  over  those  muscles.  We  see  that  the 
therepeutic  value  of  work  upon  nerve  terminals  has  been  recognized  and 
used  long  before  this.  Our  method  is  peculiar  in  this ;  that  it  works  upon 
nerve  terminals  exclusively  by  manipulation  and  its  effects. 

Perhaps  some  of  you  have  heard  of  certain  exercises  for  troubles  of 
the  stomach,  bowels,  liver,  etc.  It  is  recommended  that  the  patient  who 
has  torpid  liver  should  every  morning  get  down  on  all  fours,  that  is,  keep- 
ing the  legs  straight,  and  on  the  hands  and  feet  run  briskly  around  the 
room,  that  if  he  would  do  that  it  would  press  the  liver  and  squeeze  it  like 
a  sponge  and  could  not  help  but  stir  up  the  torpid  circulation  from  the 
portal  system.  There  is  another  stooping  motion  given  in  which  the  patient 
keeps  the  back  straight,  bends  his  knees  and  allows  his  body  to  sink  down 
straight,  then  he  can  bend  so  that  the  shoulders  touch  the  knees.  You 
will  notice  that  it  is  a  sort  of  pumping  motion,  it  will  stretch  the  spine 
and  knead  the  bowels  and  abdomen  thoroughly.  Often  this  may  be  of 
practical  use,  and  you  might  suggest  it  to  patients  with  similar  troubles. 
Now,  what  would  be  the  effect  in  such  a  case?  I  do  not  think  it  would 
be  simply  local  in  pumping  the  blood  through  the  abdomen  and  its  con- 
tents. I  think  that  the  tendency  there  would  be  to  affect  the  nerve  supply, 
if  our  work  and  our  theory  go  for  anything,  and  to  affect  generally  the 
abdominal  nerves,  and  through  them  the  centers,  which  mav  themselves 
be  in  an  abnormal  condition.  The  tendency  continuallv  toward  the  normal 
would  tell  us  why  work  upon  the  abdomen  should  affect  cerebral  centers 
and  thus  restore  them  to  the  normal.  We  had  quite  a  marked  case  in 
Chicago  some  time  since.  A  ladv  patient  told  Dr.  Sullivan  that  she  had 
been  treated  by  an  Arabian  doctor,  who  adopted  a  queer  method.  She 
said  he  had  directed  her  to  fix  her  mind  upon  the  point  in  view  every  day 
at  a  definite  time,  and  he  had  given  her  particular  instructions  as  to  how  it 
should  be  done,  and  she  said  she  wa«  perfectlv  restored  from  constipation. 
The  explanation  given  was  that  by  thus  working  on  the  mind  this  doctor 
had  finally  led  his  patient  to  gain  control  of  the  cerebral  center  which  has 
to  do  with  these  functions. 

I  have  already  examined  the  neck  before  you.  and  shown  you  how  to 
treat  it.  We  are  ready  to  take  up  the  head.  I  may  say  in  passing  that 
it  is  my  idea  to  first  go  over  the  body  part  by  part,  giving  you  the  examin- 
ation and  treatment  for  all  the  different  portions  of  the  body.  That  is  a 
piecemeal  way  to  do,  but  it  will  give  you  an  analysis  of  the  whole.  After 
I  have  done  that,  we  shall  have  a  synthesis,  and  I  will  take  up  special 
diseases,  and  show  you  how  to  examine  and  treat  the  case,  combining  dif- 
ferent movements  and  treatments  according  to  circumstances. 

II.  LANDMARKS  OF  THE  HEAD.  Holden  notes  the  following: 
That  the  scalp  is  very  tough  and  dense  on  account  of  its  close  connection 


110  LANDMARKS   OF   THE   HEAD. 

with  the  aponeurosis.  That  its  density,  therefore,  often  obscures  the 
growth  of  tumors  upon  he  cranium.  A  tumor  beneath  the  apo- 
neurosis may  very  readily  be  confused  with  a  growth  from  the  scalp  itself, 
or  from  the  brain,  and  in  general  such  tumors  are  firm  and  resisting. 
Other  tumors  that  are  above  are  very  readily  movable,  and  when  they  are 
movable  I  believe  the  point  is  general  that  they  are  not  so  serious.  The 
supra-orbital  artery  is  felt  pulsing  just  above  the  notch.  You  all  know 
where  the  supra-orbital  artery  is.  at  the  junction  of  the  inner  and  middle 
thirds  of  the  supra-orbital  arch.  It  runs  thence  up  over  the  forehead,  and 
by  carefully  feeling  you  will  be  able  to  note  the  pulse. 

The  temporal  artery  is  felt  an  inch  and  a  quarter  behind  the  external 
angular  process  of  the  frontal  bone.  The  occipital  artery  is  felt  near  the 
middle  of  a  line  drawn  from  the  occipital  protuberance  to  the  mastoid 
process.  The  posterior  auricular  artery  is  felt  pulsing  near  the  apex  of  the 
mastoid  process.  I  think  to  feel  for  the  different  arteries  at  different  places 
is  a  very  good  way  to  train  the  touch. 

It  is  said  that  the  skull  cap  is  rarely  exactly  symmetrical.  The  promi- 
nence of  the  frontal,  parietal  and  occipital  portions  of  the  cranium  is  a 
partial  indication  of  those  respective  parts  of  the  brain,  and  it  is  stated  a 
good  way  to  measure  their  relative  proportions  is  to  pass  a  string  from  one 
external  auditory  meatus  to  the  other,  first  over  the  frontal,  then  over 
the  parietal,  and  then  over  the  occipital  eminences,  and  thus  you  can  get 
an  idea  of  the  comparative  bulk  of  these  lobes  of  the  brain,  because  it  is 
said  the  lobes  of  the  brain  correspond  in  general  to  these  parts. 

The  anterior  fontanelle  in  the  infant,  you  are  familiar  with.  It  should  be 
carefully  noted  whether  the  condition  is  a  hill  or  a  hollow.  Of  course 
normally  it  is  even.  If  it  is  a  hill  it  will  indicate  too  much  cerebral  fluid 
present,  as  in  hydrocephalus.  But  if  there  is  a  wasting  of  the  fluids  of  the 
body,  as  in  diarrhea,  you  may  have  a  hollow  there.  Normally,  the  rate 
of  the  pulse-beat. may  be  counted  at  the  fontanelle  of  a  sleeping  infant.  The 
frontal  sinuses  do  not  gain  their  normal  size  until  after  puberty.  The  ab- 
sence of  them  is  not  indicative  of  much  because  they  grow  inside,  or  if 
they  are  very  prominent  it  may  be  simply  a  heaping  up  of  the  bone  and  a 
degeneration. 

The  mastoid  process  is  filled  with  air  cells,  lined  with  mucus  mem- 
brane, and  it  may  develop  as  other  mucous  membranes  do,  a  catarrhal  con- 
dition, which  may  lead  to  suppuration.  The  occipital  protuberance  is  the 
thickest  part  of  the  skull ;  about  three-quarters  of  an  inch  thick.  The  part 
at  the  temple  is  the  thinnest,  and  may  be  as  thin  as  parchment,  it  is  stated. 
The  external  auditory  canal  runs  slightly  forward  and  inward,  hence  in 
examining  you  must  pull  the  auricle  backward  and  upward. 


EXAMINATION    OF    THE    HEAD    AND    FACE.  Ill 

*MARKS  FOR  THE  FACE: — The  three  points  of  the  three  terminations 
of  the  fifth  nerve  are  at  the  supra-orbital,  infra-orbital  and  mental  fora- 
mina, respectively.  A  line  passed  from  the  supra-orbital  foramen,  between 
the  two  bicuspids,  will  pass  over  the  remaining  two  foramina.  Nerve 
terminals  are  important  with  us,  and  we  get  an  important  effect  on  the 
fifth  nerve  by  working  on  these  terminals.  The  two  lower  foramina  look 
toward  the  nose. 

III.  EXAMINATION  OF  THE  HEAD  AND  FACE :— I  do  not 
need  to  state  to  you  that  the  examination  of  the  head  and  its  parts,  em- 
bodying as  it  does,  the  eye,  ear,  nose,  and  throat,  upon  any  one  or  two  of 
which  some  spend  a  lifetime  of  study  and  work,  lecture  and  treatment, 
can  be  encompassed  by  a  few  lectures.  We  all  recognize  the  importance  of 
the  subject.  However,  I  think  we  can  take  a  general  view  of  this  subject 
now  in  a  few  lectures  and  depend  on  later  lectures  and  later  experiences 
to  enlarge  upon  our  knowledge.  The  Osteopath  has  good  success  with 
troubles  of  the  head;  brain  troubles,  diseases  of  the  eye,  ear,  nose,  and 
throat,  and  diseases  of  the  face.  His  treatment  is  very  simple,  being  for 
the  greater  part  in  the  neck.  Troubles  of  the  eye  and  ear  are,  as  you 
know,  closely  associated'  with  the  superior  cervical  ganglion  of  the  sympa- 
thetic, and  with  the  various  vertebrae.  Dislocations  of  these  vertebra?  are 
very  important.  The  atlas  will  affect  the  ear,  and  the  atlas  and  upper 
cervical  will  affect  the  eye.  So  that  in  any  examination  that  you  make  of 
the  head  and  its  parts  you  must  do  it  in  connection  with  the  neck.  Remem- 
ber that  the  separation  of  these  subjects  has  been  merely  for  convenience, 
but  that  all  work  together.  For  instance,  you  may  find  a  catarrhal  condi- 
tion of  the  head  where  the  cause  may  be  entirely  in  the  neck.  You  may 
have  a  case  of  insanity  where  the  trouble  is  wholly  in  the  neck.  With 
these  remarks  I  think  you  will  note  the  importance  of  examining  the  neck, 
and  of  treating  it  in  connection  with  head  troubles. 

In  examining  a  patient  at  any  time  you  should  note  the  size  and  shape 
of  the  head;  you  should  look  for  the  presence  of  tumors  or  ulcerations 
upon  the  scalp  or  beneath  it,  and  also  carefully  examine  to  see  if  the  head 
is  bald.  Always  notice  the  face,  as  it  is  a  great  indicator  of  disease ;  notice 
the  countenance,  and  the  expression.  You  will  frequently  meet  in  medical 
literature  the  fact  that  the  patient  has  a  worried  expression.  Different  dis- 
eases affect  the  countenance  differently,  and  you  will  often  meet  this 
anxious  expression  of  countenance,  so  that  is  an  important  indication,  as  is 
also  the  complexion.  You  have  all  seen  the  complexion  of  jaundice; 
stomach  trouble  will  have  its  effect  upon  the  complexion ;  certain  diseases 
of  the  genitals  will  cause  eruptions  on  the  face.  These  things  you  will 
bear  in  mind.  In  looking  at  the  face  always  note  the  loivcr  jaw.  It  is 

*See  Appendix  8. 


112  EXAMINATION    OF   THE   HEAD   AND   FACE. 

especially  important  from  the  Osteopathic  point  of  view.  It  may  be  slipped 
backward  or  forward  or  it  may  be  deviated  from  one  side,  and  in  being 
so  may  cause  a  tightening  of  the  ligaments  of  the  jaw  causing  serious 
results.  It  may  affect  the  ear,  or  it  may  have  something  to  do  with  neu- 
ralgia of  the  fifth  nerve. 

*In  looking  at  the  EYE,  always  notice  the  conjunctiva,  whether  or  not 
it  is  engorged  with  blood,  whether  or  not  it  is  yellow,  whether  there  is  any 
growth  upon  it,  or  any  abnormality  whatever  concerning  it.  Note  whether 
or  not  the  eye  is  brilliant ;  in  some  it  is  dull.  All  of  these  points  should  be 
significant  to  you.  There  may  be  growths  upon  the  eye,  e.  g.,  pterygium, 
which  has  been  successfully  treated  by  Osteopaths.  You  may  find  cataract; 
we  have  had  some  success  in  curing  this  also  by  Osteopathy.  It  is  well  in 
examining  a  patient  to  note  whether  or  not  the  iris  reflex  can  be  obtained. 
Dr.  Harry  Still  always  says  there  is  considerable  hope  for  an  eye  if  you 
can  find  on  examination  that  the  iris  will  readily  dilate.  He  taps  the  closed 
eye,  putting  one  finger  upon  it,  tapping  it  three  or  four  times  gently  with 
another;  if  that  has  caused  the  iris  to  dilate  you  will  know  that  the  reflex 
is  intact.  You  can  also  determine  this  by-  shutting  off  the  light  and  then 
instantly  turning  it  on,  the  reflex  being  manifest  in  the  same  way.  You 
should  in  your  examination  of  the  eye  note  what  is  the  color  of  the  mucous 
membrane.  A  very  pale  color  will  indicate  an  absence  of  sufficient  nutri- 
ment; absence  of  blood  supply.  In  anemia  the  mucous  membranes  of  the 
whole  body  are  pale,  hence  you  will  need  to  examine  the  eye  in  health  to 
acquaint  yourself  with  these  phenomena. 

In  examining  the  eye  we  have  to  turn  back  the  lids,  the  under  lid  is 
very  readily  turned  back  and  down,  and  you  can  examine  it  and  notice  if 
there  is  any  foreign  body  upon  it.  The  upper  lid  is  not  quite  so  readily 
turned  back.  You  can  do  it  with  a  pencil,  or  you  can  push  it  right  up  and 
back.  Note  the  meibomian  glands,  and  note  whether  or  not  there  are  any 
granulations  or  any  foreign  growths.  It  will  be  well  for  you  to  note 
whether  or  not  the  tonicity  of  the  muscles  about  the  eye  is  normal,  holding 
the  puncta  lachrymalia  against  the  globe  of  the  eye.  A  growth  may  obstruct 
the  duct  producing  the  same  result,  and  you  want  to  know  whether  or  not 
it  is  simply  a  loosening  of  the  muscles  or  some  obstruction  in  the  duct. 
You  may,  in  looking  at  the  eye,  discover  a  foreign  body.  Sometimes  you 
can  see  it,  sometimes  you  have  to  look  obliquely  across  the  cornea  of  the 
eye.  It  may  be  stuck  on  the  cornea,  and  you  will  have  to  look  at  it  by  an 
oblique  light  to  see  whether  the  surfaces  are  clear.  Looking  at  it  obliquely 
will  also  enable  you  to  see  pterygia,  although  these  are  generally  readily 
seen  by  looking  at  it  directly.  The  presence  of  dead  lashes  is  sufficint  cause 
of  disease ;  you  can  have  quite  a  sore  eye  merely  on  account  of  dead  lashes 


*See  Appendix  9. 


OSTEOPATHIC    POINTS   CONCERNING   THE   EYE.  113 

being  left  in  the  lids.  They  should  be  regularly  pulled  out,  and  should 
be  gently  tried  to  see  whether  or  not  they  will  come  out.  It  is  said  that 
if  a  person  will  keep  them  removed  he  will  not  have  trouble  with  his  eyes. 
When  they  have  become  lifeless  you  will  see  little  black  points  on  the  eye- 
lids. It  is  said  a  fullness  under  the  eye  is  indicative  of  dropsy.  The 
presence  or  absence  of  a  ring  about  the  eye  is  also  indicative  of  the  general 
health. 


LECTURE  XVII. 

I  spoke  last  time  of  the  phrenic  nerve,  showing  how  it  lias  connection 
with  the  sympathetic,  and  advancing  the  theory  that  very  possibly  im- 
portant results  might  by  obtained  Osteopathically  by  working  upon  this 
nerve  for  the  sake  of  influencing  its  connections,  calling  to  your  attention 
the  fact  that  it  supplies  the  peritoneum  and  pericardium;  sends  branches 
to  the  inferior  vena  cava,  and  a  branch  to  the  right  auricle  of  the  heart.  It  is 
also  connected  with  the  sympathetics  below  the  diaphragm,  and  thus  has 
very  important  connections  with  visceral  life.  It  is  also  connected  with  a 
cranial  nerve,  the  hypoglossal,  and  with  spinal  nerves,  viz. ;  the  3d,  4th,  and 
5th  cervicals,  and  that  in  some  animals  connection  had  been  noted  between 
the  phrenic  and  three  lower  intercostal  nerves.  This  connection  with  the 
muscles  of  respiration  is  to  cause  them  to  work  in  conjunction.  There  is 
the  theory  supported  by  the  quotation  from  Dr.  Jacobson — that  work  upon, 
or  exercises  that  would  influence,  the  abdominal  viscera,  would  thus  have 
an  influence  upon  the  brain.  It  seems  likely  that  by  work  upon  these  parts 
we  can  get  an  influence  over  the  parts  affected,  and  thus  perhaps  reach 
brain  centers  and  gain  an  influence  over  them.  I  noted  also  the  value 
of  such  exercises  as  stooping,  those  which  would  bring  a  squeezing  motion 
upon  the  liver,  intestines  and  stomach,  and  showed  how  it  might  through 
these  nervous  connections  affect  the  parts  which  were  at  fault.  I  then 
explained  certain  points  concerning  landmarks  about  the  head  and  face, 
and  spoke  upon  the  subject  of  how  to  examine  the  head,  face  and  its  parts. 
I  wish  to-day  to  continue  that  line  of  thought,  giving  particular  attention 
to  the  eye. 

*I.  OSTEOPATHIC  POINTS  CONCERNING  THE  EYE:— We 
are  aware  that  the  nerve  supply  of  the  eye,  which  is  itself  a  nervous  organ, 
is  various  and  important,  and  we  shall  see  later  in  the  lecture  that  we  have 
quite  a  broad  field  upon  which  to  work  to  reach  the  eye.  I  have  already 
given  you  some  centers  for  the  eye  and  have  spoken,  in  considering  the 


*See  Appendix  10. 


114  OSTEOPATHIC    POINTS    CONCERNING   THE    EYE. 

neck,  about  the  blood  supply  to  the  head  and  its  parts.  We  get  our  effect 
upon  it  through  the  nerves;  the  superior  cervical  ganglion  is  the  chief 
center  upon  which  we  work  to  affect  the  eye.  I  have  seen  a  case  of  "blood- 
shot"' eye,  as  we  call  it,  cured  by  treating  in  the  superior  cervical  region ; 
simply  by  inhibiting  the  action  of  the  sympathetics  at  that  place.  So  you 
see  the  superior  cervical  ganglion  has  an  important  control  over  the  me- 
chanism of  the  blood  supply.  We  probably  affect  it  through  the  ascending 
branch  to  the  carotid  and  cavernous  plexuses,  and  no  doubt  also  through 
the  connection  which  it  has  with  the  fifth  nerve — the  fifth  nerve  having 
important  vaso-motor  fibres  to  the  eye.  Quain,  in  his  anatomy,  describes 
branches  from  the  cavernous  plexus  which  run  to  the  cerebral 
and  ophthalmic  arteries,  forming  a  secondary  plexus  about  them,  and  from 
them,  he  says,  some  branches  go  to  the  eye-ball  and  form  a  plexus  of  the 
sympathetic  in  the  eye-ball  itself.  Hence,  we  have  a  very  important  and 
direct  connection  with  the  sympathetic  through  the  superior  cervical  gang- 
lion, through  its  ascending  branches,  and  this  terminal  sympathetic  plexus 
in  the  eye-ball.  The  ciliary  ganglion  is  also  important  in  relation  to  our 
work  upon  the  eye.  It  has  connection  with  the  third  and  fifth  cranial 
nerves  and  the  sympathetics.  The  third  and  fifth  nerves  are  important, 
as  you  will  see  later  when  I  shall  take  that  up  more  in  detail.  Concerning 
the  ciliary  ganglion,  Quain  says ;  "The  ciliary,  ophthalmic  or  lenticular 
ganglion  serves  as  a  center  for  the  supply  of  nerves,  motor,  sensory  and 
sympathetic,  to  the  eye-ball."  Thus  we  have  a  center  on  which  we  may 
work.  Further,  he  says ;  "The  sympathetic  root  is  a  very  small  nerve 
which  emanates  from  the  cavernous  plexus."  So  the  ciliary  ganglion  gets 
its  sympathetic  supply  for  the  eye  from  the  cavernous  plexus.  The  ciliary 
ganglion  lies  at  the  bottom  of  the  orbit  between  the  rectus  muscle  and  the 
optic  nerve. 

There  is  a  treatment  which  we  frequently  give  the  eye,  not  tapping, 
but  a  PRESSURE  of  the  eye  back  into  its  socket ;  and  I  think  the  effect  there 
must  be  on  the  ciliary  ganglion,  and  since  it  is  connected  with  the  third 
and  fifth  nerves^  we  could  undoubtedly,  if  there  were  abnormalities,  get 
an  effect  upon  those  nerves.  Thus,  working  in  this  way,  we  might  affect 
the  third  nerve  and  tone  up  the  muscular  mechanism  of  the  eye,  or 
working  in  this  direction  on  the  fifth  nerve,  we  might  tone  up  the  nutri- 
tion of  the  eye.  Thus  by  pressure  we  have  reached  not  a  nerve,  but  a 
center,  and  the  reverse  is  clearly  true  according  to  our  theory,  that  we 
might  work  upon  terminals,  as  for  instance  terminals  of  the  fifth  nerve 
which  are  readily  reached  in  the  face,  and  in  that  way  get  an  effect  upon 
this  ciliary  ganglion  which  is  connected  with  the  fifth  nerve.  Or,  by 
working,  as  we  do,  through  the  superior  cervical  ganglion  to  reach  the 
third  nerve,  we  might  have  an  effect  upon  the  ciliary  ganglion,  through 
its  sympathetic  connection.  This  will  serve  to  show  you  how  closely 


THE   THIRD   AND   FIFTH   NERVES   IN    RELATION   TO   THE    EYE.  115 

connected  is  all  this  nerve  supply  to  the  eye.  One  is  quite  dependent 
upon  the  other,  and  in  affecting  the  one  you  affect  the  other,  provided  it 
is  in  need  of  treatment.  Thus  by  working  on  this  theory  you  can  affect 
not  only  sympathetic  life,  but  sensation  and  motion  of  the  eye.  since 
these  nerves  send  branches  to  the  eye. 

A  little  further  with  regard  to  the  third  nerve  and  its  connection  with 
the  eye  ball.  It  innervates  all  the  muscles  of  the  eye  ball,  as  you  know. 
except  the  external  rectus  and  superior  oblique.  Through  the  ciliary 
ganglion  it  also  rules  the  sphincter  of  the  iris.  Howell's  Text  Book  states 
that  there  are  fibres  antagonistic  to  this  motor  oculi  from  the  ciliary 
ganglion,  which  constrict  the  iris  and  lesson  the  aperature  of  the  pupil. 
The  antagonistic  fibres  to  the  motor  oculi  come  from  the  third  ventricle. 
through  the  bulb,  the  cervical  cord,  the  anterior  roots  of  the  upper  dorsal 
nerves,  the  upper  thoracic  ganglion,  and  the  cervical  sympathetic  cord, 
and  thus  they  join  the  ophthalmic  division  of  the  fifth  nerve,  passing 
through  its  nasal  branch  and  its  long  ciliary  branches  to  the  iris.  These 
antagonistic  fibres  must  be  dilators.  Thus  from  the  motor  oculi  you  get 
the  motor  fibres  to  the  sphincter  of  the  iris,  and  from  the  region  I  have 
just  explained  you  get  the  dilator  fibres  of  the  iris.  Hence,  we  dilate  the 
iris  by  stimulating  the  superior'  cervical  ganglion  or  stimulating  in  the 
upper  dorsal  region,  more  particularly  the  latter.  Quain.  in  speaking 
of  fibres  from  the  cervical  ganglion,  notes  these  centers:  pupillo-dilator 
arising  from  the  ist.  2nd  and  3rd  dorsal  nerves,  then  passing  upward  in 
the  ascending  branch  of  the  superior  cervical  ganglion,  reaching  the  Gas- 
serian  ganglion  and  the  eye  through  the  first  division  of  the  fifth  nerve 
and  the  long  ciliary  nerves.  He  further  says  in  parenthesis  that  it  is 
stated  by  many  observers  that  the  pupillo-dilator  fifcers  are  contained  also 
in  the  7th  and  8th  cervical  nerves.  Motor  fibres  run  to  the  involuntary 
nmscles  and  orbit  and  the  eye  lids  from  the  higher  four  or  five  dorsal 
nerves.  Thus  along  the  cervical  region,  from  the  superior  cervical  gang- 
lion down  as  low  as  the  6th  dorsal,  you  may  get  an  important  effect  upon 
the  eye. 

Concerning  the  FIFTH  NERVE  and  its  connection  with  the  eye  ball,  I 
have  already  noted  its  connection  with  the  ciliarv  mechanism:  that  there 
are  dilator  branches  from  the  cervical  and  upper  dorsal  through  the  nasal 
branch  of  the  fifth,  and  that  it  has  connection  with  the  Gasserian  gang- 
lion. The  ophthalmic  or  first  division  of  the  fifth  nerve,  which  is  sensory 
in  function,  joins  with  branches  from  the  sympathetic  derived  from  the 
cavernous  plexus.  This  nerve  supplies  the  lachrymal  glands,  the  con- 
junctiva of  the  lids  and  of  the  eye  ball,  and  the  skin  about  the  lid  and 
face  of  that  part.  The  fifth  nerve  is  also  very  important  in  the  nutrition 
of  the  eye,  the  face,  and  different  parts  of  the  head.  Green's  Pathology 
notes  the  fact  that  upon  section  of  the  fifth  nerve  keratitis.  or  inflamma- 


11G  THEORY   OF    OSTEOPATHIC   WORK    UPON    THE   EYE. 

tion  of  the  cornea  arises,  fillowed  by  ulceration.  Kirke  makes  the  same 
statement,  and  says  further  that  the  disease  may  progress  "so  far  as  to 
destroy  the  whole  eye-ball.  Kirke  also  states  that  in  the  case  of  the  fifth 
nerve,  the  fact  that  there  are  trophic  fibres  in  it  is  proven  by  experiments 
of  Meissner  and  Buttner,  who  found  that  division  of  the  innermost  fibres 
is  most  potent  in  producing  decay.  Howell's  Text  Book  states  that  vaso- 
dilator fibres  for  the  face  and  mouth  are  found  in  the  cervical  sympa- 
thetics;  that  they  leave  the  cord  at  the  second  to  the  fifth  dorsal;  that 
they  connect  with  the  fifth  nerve  by  passing  from  the  superior  cervical 
ganglion  to  the  Gasserian  ganglion.  Other  dilator  fibres  for  the  skin  and 
mucous  membrane  of  the  mouth-  and  face  seem  to  arise  in  the  fifth  nerve 
itself,  also  some  in  the  nerve  of  Wrisberg.  He  states  further  that  excita- 
tion of  the  cervical  sympathetic  causes  constriction,  excitation  of  the 
thoracic  sympathetic,  dilation  of  the  retinal  arteries.  Thus  by  working 
from  the  cervical  sympathetic,  getting  an  influence  along  the  path  of  the 
fifth  nerve,  you  have  a  vaso-motor  effect  upon  the  retina.  So  you  have 
not  only  trophic  but  vaso-motor  fibres  in  the  fifth  nerve,  supplying  the 
eye.  Quain  states  further  that  the  retinal  fibres,  leaving  the  sympathetic 
at  the  superior  cervical  ganglion,  pass  to  the  ganglion  of  Gasser  and  to 
the  eye  from  the  ophthalmic  branch  of  the  fifth  nerve,  through  the  gray 
root  of  the  ophthalmic  ganglion  and  the  ciliary  nerves.  Almost  all  of 
the  trophic  fibres  of  the  anterior  part  of  the  eye  are  found  in  the  fifth  nerve, 
hence  you  can  readily  see  the  great  importance  that  the  fifth  nerve  bears 
to  Osteopathic  work  upon  the  eye,  because  there  is  hardly  any  trouble 
in  the  eye  which  may  not  be  influenced  through  the  nutrition,  and  such 
troubles  are  within  the  reach  of  the  Osteopath. 

Taking  into  consideration  the  facts,  then,  we  note  first,  that  the  eye 
is  readily  reached  by  the  Osteopath  in  two  ways;  through  its  blood  sup- 
ply, and  through  its  nerve  supply.  We  note  further  that  the  chief  points 
at  which  the  Osteopath  works  to  affect  the  eye  are  the  third  nerve,  the 
fifth  nerve,  the  superior  cervical  ganglion,  the  upper  dorsal  region,  and 
also  the  ciliary  ganglion;  that,  as  I  noted  in  the  beginning,  the  superior 
cervical  ganglion  is  the  most  important  point  upon  which  we  work  in 
treating  the  eye,  since,  as  you  have  seen,  it  is  connected  with  the  third 
and  fifth  nerves,  and  also  with  the  ciliary  ganglion.  Also  that  through 
it  you  get  an  effect  upon  the  iris,  upon  muscles,  and  upon  nutrition  and 
sensation  in  general.  The  Osteopath  certainly  is  not  lacking  for  means 
of  reaching  the  eye. 

We  note  further  that  there  is  a  constrictor  center  for  the  iris  in  the 
ciliary  ganglion  and  in  the  superior  cervical  ganglion ;  that  there  is  also  a 
dilator  center  in  the  upper  dorsal  region  and  in  the  superior  cervical 
ganglion.  That  is,  dilator  center  for  the  iris.  It  may  be  a  little  confus- 
ing, that  in  the  superior  cervical  ganglion  you  may  have  both  a  con- 


LANDMARKS   OF   THE   FACE.  117 

stricter  and  dilator  center  for  the  iris.  However  we  may  contract  the  iris 
by  working  at  the  upper  cervical  region,  and  we  may  dilate  it  by  work- 
ing down  at  the  second  and  third  dorsal.  That  has  been  our  experience. 
and  although  there  seems  ":o  be  a  confusion  of  centers  there  we  go  accord- 
ing to  results.  We  may  work  in  one  way  upon  the  fifth  nerve  by  treating 
the  superior  cervical  ganglion,  and  we  get  an  important  effect  upon  the 
fifth  nerve  by  working  up  its  terminal  branches.  As  I  pointed  out  to 
you  at  the  last  lecture,  the  terminal  branches  of  the  fifth  nerve  are  read- 
ily pressed  upon  at  the  supra-orbital  and  infra-orbital  foramina,  as  well 
as  at  the  mental  foramen,  and  since  we  have  shown  that  working  upon 
terminal  fibres  is  an  important  part  of  our  work,  and  that  through  them 
we  can  gain  important  effects  upon  connected  nervous  mechanism,  it 
shows  that  we  have  a  good  opportunity  to  reach  and  effect  the  nervous 
mechanisms  of  the  eye  through  the  fifth  nerve. 

I  also  noted  at  the  last  lecture  the  importance  of  examining  the  neck 
in  any  trouble  of  the  eye  or  part  of  the  head.  If  there  is  any  dislocation 
of  the  atlas  or  of  the  third  cervical,  these  points  are  particularly  signifi- 
cant in  regard  to  eye  troubles,  or  there  may  be  an  interference  at  the 
inferior  maxillary  articulation — impinging  upon  fibres  of  the  inferior 
maxillary  division  of  the  fifth  nerve,  and  since  in  that  way  you  may  affect 
the  whole  nerve,  it  may  have  an  effect  upon  the  eye. 

Byron  Robinson  quotes  from  Fox  that,  "Irritation  of  the  peripheral 
end  of  the  cervical  sympathetic  will  cause  a  protrusion  of  the  eye-ball, 
while  section  will  cause  a  sinking  of  the  eye-ball."  There  are  fibres 
which  aid  in  the  control  of  the  metabolism  of  the  retina  at  the  fourth 
and  fifth  dorsal.  Strong  stimulation  of  the  nerves  of  the  sexual  organs 
causes  dilation  of  the  pupils  and  protrusion  of  the  eye-ball. 

II.  FURTHER  LANDMARKS  IN  REGARD  TO  THE  PARTS 
OF  THE  HEAD  AND  FACE.— According  to  Hclden  we  notice  the  fol- 
lowing points.  You  will  readily  feel  the  pully  of  the  superior  oblique 
muscle  by  pressing  the  thumb  just  under  the  inner  edge  of  the  orbit.  The 
seventh  nerve  has  its  exit  from  the  cranium  at  the  stylo-mastoid  foramen. 
It  then  passes  forward  and  runs  into  the  parotid  glands.  It  sends  branches 
upward  to  the  temple,  toward  the  eye,  the  cheek  and  jaw.  The  parotid  duct 
lies  on  a  line  drawn  from  the  bottom  of  the  lobe  of  the  ear  to  midway 
between  the  nose  and  the  mouth,  and  empties  opposite  the  upper  second 
molar  tooth.  It  is  accompanied  by  a  branch  of  the  facial  nerve  supplying 
the  buccinator  muscle.  The  pulsation  of  the  temporal  artery  may  be  felt 
between  the  root  of  the  zygoma  and  the  anterior  part  of  the  ear.  It  is 
said  that  that  is  a  very  convenient  place  to  feel  the  pulse  of  a  sleeping 
patient.  The  facial  artery  is  very  important  in  our  work.  It  passes  over 
the  inferior  maxillary  bone  at  the  anterior  edge  of  the  masseter  muscle,  and 
is  felt  also  at  the  side  of  the  nose  high  up,  as  well  as  near  the  corner  of 


118  EXAMINATION    OF   THE    EYE.      TREATMENT   OF    THE    EYE. 

the  mouth  close  to  the  mucous  membrane.  The  coronary  arteries  are 
readily  felt  by  placing  the  finger  just  beneath  the  lip  against  the  mucous 
membrane;  you  can  feel  them  pulsate  on  the  inner  side  of  the  upper  lip 
and  on  the  inner  side  of  the  lower  lip.  The  facial  vein,  instead  of  taking  a 
tortuous  course  to  follow  the  artery,  runs  directly  from  the  inner  angle  0f 
the  eye  down  to  the  anterior  border  of  the  masseter  muscles. 

III.  EXAMINATION     OF    THE     EYE.— (Continued.)— I     took 
this     subject     up  at     the     last    lecture,     but     there     are     some     points 
that  I  wish  to  call  to  your  attention  in  examining  the  eye.    An  unnatural 
luster  of  the  eye  is  seen  in  fevers.     An  unnatural  brilliancy  is  found  in 
consumptives.     A  glassy  eye  in  children  shows  inflammation  of  the  mes- 
enteric  glands,  and  if  it  is  accompanied  by  dark,  dry  lips  and  tongue  and 
great  restlessness,  it  shows  an  acute  inflammation  of  the  stomach.     In 
fevers  glassy  eyes  are  a  sign  of  great  danger  or  of  some  serious  change 
about  to  occur.     Dull  eyes  are  noticed  in  febrile  conditions,  during  the 
catamenia.  in  catarrhal  and  other  affections.     Sunken  eyes  are  due  to  the 
absorption  of  the  fatty  cushions,  and  indicate  some  loss  of  the  vital  fluid, 
hemorrhage  or  some  exhausting  disease.     Exophthalmus,  protrusion  of 
the  eye-ball,  when  not  congenital,  is  said  to  be  characteristic  of  Basedow's 
or  Graves'  disease. 

In  your  examination  of  the  eye  you  should  bear  in  mind  and  see  what 
parts  of  the  eye  are  affected:  whether  it  is  the  lid,  iris  or  conjunctiva; 
whether  it  is  a  change  in  the  eyejball,  whether  the  sight  is  affected,  or 
there  be  a  weakening  of  the  nerves,  or  inflammation  of  the  eye. 

IV.  TREATMENT  OF  THE  EYE.— As  I  have  said,  the  treatment 
of  the  eye  Osteopathetically  is  quite  a  simple  matter.     In  the  first  place,  as 
I  noted,  we  sometimes  bring  direct  pressure  upon  the  eye.     We  with  one 
hand  press  gently  upon  the  eye-ball,  or  you  can  lay  your  thumb  on  it  and 
press  downward.     In  that  way,  as  I  explained  to  you,  you  probably  have 
an  effect  upon  the  ciliary  ganglion,  you  would  also  mechanically  excite 
the  blood  supply  by  pressure.     You  would  have  an  effect  through  this 
pressure  upon  the  optic  nerve,  since  all  these  parts  by  being  pressed  back 
into  the  cavity  would  be  more  or  less  impinged  upon.     I  noted  that  we 
sometimes  gently  tapped  the  eye,  laying  qne  finger  upon  the  eye,  and 
with  another    tapping  three  or  four  times  very  gently.     The  idea  in  that 
is  to  shock  the  optic  nerve  and  thus  stimulate  it.     In  that  way  we  also 
stimulate   the   sympathetics,   and   through   them   the   blood-supply.     We 
frequently,  in  treatment  of  the  head,  tap  upon  the  frontal  sinus,  not  very 
hard,  for  troubles  with  a  branch  of  the  fifth'  nerve  which  supplies  that 
sinus,  and  from  which  you  might  have  a  bad  effect  upon  the  eye,  causing 
some  pain,   which  you   might   relieve   in   that   way.     We   are   frequently 
called  upon  to  treat  granulated  eyelids.    They  are  something  that  are  read- 
ily treated  by   Osteopathic   means,  and   something  which  are  very  dis- 


TREATMENT   OF   THE   EYE.  119 

tressing  to  the  eye.  We  wet  the  finger  with  a  little  water  or  oil,  sweet 
oil  or  vaseline,  and  press  it  under  the  edge  of  the  lid,  both  above  and 
below,  and  then  pressing  with  the  thumb  against  the  outside  of  the  lid 
upon  the  finger,  worK  with  the  thumb  and  finger  along  the  edge  of  the 
lid.  In  that  way  you  stimulate  the  local  blood-flow.  The  thickening 
causing  the  granulations  is  said  to  be  due  sometimes  to  a  local  hyper- 
trophy of  the  conjunctiva,  or  sometimes  to  a  stopping  of  the  ducts  of 
the  meibomian  glands.  In  thus  working  3-011  would  stimulate  the  blood- 
flow  to  make  that  conjunctiva  normal,  or  you  would  take  away  the 
stoppage  of  the  ducts  of  the  glands.  Sometimes  the  secretion  gets  thick 
and  occludes  the  ducts.  I  have  often  heard  Dr.  Hildreth  speak  of  quite 
a  noted  case  of  granulated  eyelids  which  was  entirely  cured.  He  said 
that  Dr.  Still  explained  that  there  was  a  stoppage  of  the  circulation,  that 
the  blood  had  to  make  some  use  of  the  nutriment  which  was  carried 
there,  and  instead  of  it  being  directed  normally  it  was  directed  abnormally 
on  account  of  the  stoppage,  and  so  caused  these  abnormal  growths.' 
What  he  did  was  free  the  circulation.  In  any  treatment  of  the  eye  we 
must  work  over  the  superior  cervical  ganglion  to  get  our  effect  upon  the 
circulation. 

I  spoke  about  points  at  which  we  can  reach  the  fifth  nerve.  Particu- 
larly in  work  upon  the  eye  we  work  at  the  supra-orbital  notch  or  fora- 
men, here  at  the  junction  of  the  inner  and  middle  third  of  the  arch.  Be 
careful  to  free  that  so  that  any  contraction  of  the  tissues  about  it  are 
thoroughly  relaxed.  Then  the  same  thing  should  be  done  below,  at  the 
infra-orbital  foramen.  We  also  get  a  termination  of  the  fifth  nerve  at 
the  outer  angle  of  the  eye,  and  I  always  work  carefully  there  and  stimu- 
late that  branch  of  the  fifth  nerve.  There  is  said  to  be  a  terminal  branch 
just  over  the  middle  of  the  eye  lid,  and  a  terminal  branch  at  the  inner 
canthus  of  the  eye,  on  the  nose,  where  we  can  readily  impinge  upon  it. 
A  terminal  branch  is  found  also  upon  each  side  of  the  midline  of  the 
forehead.  According  to  the  theory  that  we  can  work  upon  nerve  ter- 
minals, as  we  frequently  do,  to  gain  an  important  effect  upon  the  con- 
nected parts,  we  here  have  a  number  of  terminal  branches  of  the  fifth 
nerve  which  we  could  ceitainly  influence  in  that  way  to  restore  the  nor- 
mal. At  these  places  we  also  get  the  little  blood  vessels,  here  at  the 
inner  canthus  and  at  the  foramina,  and  free  them  in  our  treatment. 
Another  way  that  is  sometimes  employed  almost  exclusively  in  work 
upon  the  eye  is  to  have  a  patient  spring  the  mouth  open  while  you  hold 
the  jaw,  the  idea  being  to  free  the  blood  supply  through  the  carotids, 
since  the  blood-supply  of  the  eye  is  derived  from  the  internal  carotids, 
and  it  is  a  very  important  point  in  relation  to  work  upon  the  eyes.  We 
must  not  forget  the  point  I  mentioned  in  regard  to  the  neck,  and  which 
you  are  familiar  with,  but  the  great  and  important  point  upon  which  we 


120  CENTERS   FOR    PARTS   OF   THE   HEAD. 

work  is  the  superior  ganglion.  Thoroughly  relax  everything  and  remove 
every  pressure  which  may  affect  the  'blood  flow.  I  showed  you  how  to 
inhibit  the  action  of  the  cervical  sympathetic  by  holding.  Stimulating 
would  be  the  opposite — working  quickly  with  alternate  pressure  and  re- 
laxation. 


LECTURE  XVIII. 

At  the  last  lecture  I  took  up  points  in  regard  to  the  eye,  giving  you 
various  centers,  which  I  need  not  repeat  here.  Also  I  noted  the  import- 
ance of  the  ciliary  ganglion  in  connection  with  the  eye,  the  importance 
of  the  third  nerve  in  relation  with  the  eye;  also  of  the  fifth  nerve  in 
nutrition  of  the  eye  and  parts  of  the  head  and  face.  Then  I  brought  out 
certain  points  of  importance  to  us  as  Osteopaths.  I  noted  certain  land- 
marks concerning  the  head  and  face;  concluded  the  examination  and 
took  up  the  treatment  of  the  eye.  I  wish  to-day  to  continue  our  con- 
sideration of  points  about  the  head  and  face. 

I.  CERTAIN  CENTERS  FOR  THE  PARTS  OF  THE  HEAD: 
— I  have  already  mentioned  some  in  previous  lectures.  Howell's  Text 
Book  states  that  the  cervical  sympathetic  contains  vaso-constrictor  fibres 
for  the  face,  the  eye,  the  ear,  the  salivary  glands,  the  tongue,  and  perhaps 
the  brain.  As  to  vaso-motor  nerves  to  the  tongue;  the  lingual  and 
glosso-pharyngeal  nerves  contain  vaso-dilator  fibres,  while  the  hypo- 
glossal  and  sympathetics  contain  vaso-constrictor  fibres.  The  chorda 
tympani,  as  already  noted,  is  the  vaso-dilator  of  the  submaxillary  gland. 
Quain  states  that  the  secretory  fibres  of  the  submaxillary  gland  arise 
mainly  from  the  second  and  third  dorsal.  Dana  states  that  herpes,  flush- 
ing, pallor,  lachrymation  and  salivation  indicate  some  disturbance  of  the 
sympathetic  and  trophic  fibres  contained  in  the  fifth  nerve.  Quain  states 
further  that  the  glosso-pharyngeal  nerve,  through  its  small  superficial 
petrosal  branch,  furnishes  secretory  and  vaso-dilator  fibres  to  the  parotid 
gland. 

*In  view  of  these  facts,  and  of  facts  which  I  have  already  presented, 
I  wish  to  call  the  following  points  to  your  attention:  First,  that  you 
have  already  been  shown  how  to  reach  and  treat  the  fifth  nerve,  the  cerv- 
ical sympathetic,  the  lingual,  which  is  a  branch  of  the  facial,  and  the 
glossopharyngeal.  I  have  brought  up  further  the  hypoglossal  nerve, 
which  is  reached  by  the  Osteopath  indirectly  by  the  treatment  of  the 
superior  cervical  sympathetic  ganglion.  The  Osteopath  thus  controls 
the  nerve-supply  of  all  parts  of  the  head  practically,  and  through  the 

*See  Appendix  n. 


THE   EYE.      LANDMARKS.  121 

nerve-supply  the  blood  to  the  head,  governing  as  he  does,  by  his  work 
upon  the  neck,  the  blood-flow  to  all  parts  of  the  head,  he  must  have  an 
important  effect  upon  nutrition.  A  further  point  is  that  the  Osteopathic 
work  is  very  simple,  and  is  made  up  largely  of  treatment  in  the  neck, 
particularly  at  the  superior  cervical  ganglion.  I  say  very  simple,  because 
it  is  so  in  certain  respects,  but  very  complex  when  you  come  to  study 
out  the  various  complex  relations  of  the  nerves,  and  the  effect  we  may 
get  upon  them  by  working  upon  centers. 

II.  LANDMARKS. — Holden  instances  the  following  points.  The 
opening  between  the  eyelids  varies  in  size  in  different  persons.  It  is  this 
change,  and  not  a  variation  in  the  size  of  the  eyeball,  which  makes  us  say 
a  person  has  a  large  or  small  eye,  as  the  eyeballs  are  very  nearly  of  the 
same  size  in  different  individuals.  The  external  angle  of  the  lid  is  gen- 
erally a  little  higher  than  the  internal  angle,  and  gives  an  arch  expression 
to  the  face.  The  closed  lids  fit  accurately  together,  and  are  not  beveled,  as 
sometimes  stated,  to  form  a  channel  with  the  ball  of  the  eye  for  the  flow 
of  the  tears.  Upon  shutting  the  eye  the  ball  turns  slightly  upward  and 
inward,  in  that  way  cleansing  the  cornea  of  any  foreign  substance  which 
may  have  dropped  upon  it,  and  also  turning  the  pupil  away  from  the  light. 
The  puncta  lachrymalia  are  familiar  to  you;  they  are  seen  at  the  inner 
angle  of  each  lid.  The  lachrymal  sac  is  found  by  drawing  the  eyelids  out- 
ward, tensing  in  that  way  the  tendo  oculi,  which  crosses  the  lachrymal  sac 
about  the  middle.  By  placing  your  finger  upon  the  tendo  oculi  you  can 
feel,  by  winking  the  eye,  that  the  orbicularis  palpebrarurn  and  the  muscles 
about  the  eye,  keep  that  tendon  working  so  that  the  tears  are  pumped 
into  the  lachrymal  sac  and  passed  into  the  nasal  duct.  The  nasal  duct  is 
from  six  to  eight  lines  long,  and  passes  from  the  lachrymal  sac  downward. 
It  opens  at  the  top  of  the  inferior  meatus  or  sometimes  in  the  outer  wall. 
The  left  nostril,  you  will  see  upon  examination,  is  usually  narrower  than 
the  right,  owing  to  a  deviation  of  the  septum  toward  the  left.  It  is  im- 
portant to  know  these  points,  so  that  you  will  recognize  the  normal  condi- 
tions and  not  confuse  them  with  disease.  The  middle  and  inferior  spongy 
bones  may  be  seen  by  dilating  the  nostril  and  throwing  the  head  back.  They 
are  red  in  color  and  must  be  carefully  distinguished  from  polypi. 

The  Osteopath  should  also  note  the  color  of  the  lips,  the  normal  ver- 
milion color  indicating  health,  and  a  departure  from  this  indicating  either 
the  state  of  the  circulation  or  condition  of  the  blood.  In  looking  into  the 
mouth  always  bear  in  mind  to  look  at  the  condition  of  the  tongue,  as  it  is 
a  great  indicator  of  disease.  Upon  the  under  surface  of  the  tongue  is  a 
median  furrow  upon  each  side  of  which  is  the  ranine  vein.  In  the  middle 
line  of  the  floor  of  the  mouth  is  the  frenum  linguae,  upon  each  side  of 
which  is  the  opening  of  the  duct  of  Wharton,  leading  from  the  submaxil- 
lary  glands,  which  you  may  find  beneath  the  mucous  membrane  back  near 


122  EXAMINATION    OF  THE  THROAT. 

the  angle  of  the  jaw.  The  sub-lingual  glands  are  in  the  ridge  of  mucous 
membrane  each  side  of  the  middle.  The  shape  of  the  hard  palate  is  some- 
times significant,  ^usually  a  broad  arch.  It  is  sometimes  narrower  at  the 
top  like  a  Gothic  arch,  and  it  is  said  that  in  idiots  it  is  quite,  acute. 

In  examining  the  THROAT  it  is  a  good  plan,  it  is  said,  to  close  the  nos- 
trils so  that  the  person  is  obliged  to  breathe  through  the  mouth.  That 
will  cause  a  dilation  of  the  various  parts  of  the  throat,  a  widening  of  the 
fauces  and  a  raising  of  the  soft  palate,  so  that  you  can  then  get  a  good 
view  of  the  internal  parts  of  the  throat.  When  you  depress  the  tongue 
it  should  be  done  gently  with  your  finger  or  the  handle  of  a  spoon,  or 
something  of  that  kind.  If  you  are  rough,  the  tongue  will  resist  the  effort 
you  are  making  to  lower  it.  The  operator  can  pass  his  finger  down  into 
the  throat  past  the  epiglottis  as  far  as  the  inferior  border  of  the  cricoid 
cartilage ;  as  far  as  the  beginning  of  the  oesophagus,  and  can  make  out  the 
greater  cornua  of  the  hyoid  bone  and  seek  in  the  hyoid  spaces  on  each  side 
where  any  foreign  body  is  quite  apt  to  lodge.  It  is  important  to  know  that 
behind  the  last  molar  tooth  there  is  a  small  aperature  through  which  a 
little  tube  may  be  introduced  through  which  to  feed  a  patient  in  spasmodic 
closure  of  the  lower  jaw.  The  pterygo-maxillary  ligament  is  seen  opposite 
the  last  molar  tooth.  The  place  where  the  surgeon  taps  the  antrum  is  just 
above  the  second  bicuspid  tooth,  about  an  inch  above  the  margin  of  the 
gum.  The  aperature  of  the  posterior  nares  may  be  felt  by  passing  the 
finger  carefully  up  behind  the  soft  palate,  and  there  can  be  made  out  by 
the  touch  the  back  of  the  septum  and  the  back  of  the  inferior  spongy  bone 
in  each  nostril,  also  a  grasping  feeling  from  the  action  of  the  superior  con- 
strictors of  the  pharynx. 

I  have  already  spoken  concerning  the  tonsils.  They  lie  at  the  side  of 
the  throat,  just  behind  the  pillars,  and  in  examination  of  the  throat  if  you 
see  them  extending  beyond  those  pillars,  it  shows  they  are  abnormal  in 
size.  The  normal  tonsil  does  not  extend  beyond  the  pillars. 

I  have  mentioned  physiognomy  in  relation  to  examination  of  the  face. 
It  is  stated  that  the  insertion  of  the  muscles,  not  only  into  tendons  and 
bony  parts  of  the  face,  but  also  into  the  skin  all  over  the  face,  leads  to 
the  formation  of  lines.  The  passage  of  various  thoughts  through  the 
mind  constantly  recurring,  calls  into  play  certain  sets  of  muscles,  and 
finally  leaves  lines  upon  the  skin  at  the  places  of  contraction,  thus  creating 
a  reliable  method  by  which  the  countenance  may  be  read,  and  which  is 
sometimes  useful  to  us.  There  are  two  of  these  lines  which  I  wish  to 
mention  particularly.  First,  there  is  the  linea  nasalis,  extending  from  the 
alae  nasi  out  to  the  angle  of  the  mouth.  It  is  said  that  in  children  its 
presence  denotes  some  abdominal  trouble,  especially  inflammation  of  the 
bowels;  in  older  persons  some  trouble  with  the  stomach,  or  abdominal 
disease,  frequently  of  the  liver.  The  linea  labialis  extends  from  the  angle 


EXAMINATION    OF    THE    EAR.  123 

of  the  mouth  down  to  the  side  of  the  jaw.  It  is  seen  frequently  in  children 
with  inflammatory  diseases  of  the  larynx  or  lungs,  and  in  older  people 
who  have  laryngeal  and  bronchial  trouble,  and  difficulty  of  breathing.  Of 
course  the  Osteopath,  as  well  as  the  physician,  should  become  familiar 
with  the  indications  of  the  face.  They  are  interesting  to  study  and  are 
very  practical  in  directing  the  operator's  attention  to  the  probabilities  of 
disease — they  are  very  helpful  in  diagnosis. 

I  wish  to-diay  to  examine  further  the  parts  of  the  head,  and  show 
you  the  treatment  to  be  given. 

III.  EXAMINATION  OF  THE  EAR.  The  disease  may  be  in 
the  external,  in  the  internal,  or  in  the  middle  ear,  or  it  may  be  in  the 
brain  or  in  the  auditory  nerve  itself.  It  is  sometimes  very  difficult  to  say 
where  the  location  of  the  disease  is.  First:  As  to  examination  of  the 
external  auditory  canal,  since  it  runs  forward  and  inward  and  is  slightly 
curved,  you  must  draw  the  auricle  upward  and  backward  to  be  able  to 
look  down  into  the  external  canal.  You  must  have  a  good  light.  You 
can  look  directly  in  without  the  aid  of  any  instrument,  but  usually  the 
operator  should  be  supplied  with  an  ear  speculum,  which  is  a  little  tube, 
funnel  shaped,  polished  so  as  to  reflect  the  light.  Frequently  a  forehead 
mirror  is  used;  a  little  mirror  that  is  fastened  by  a  band  about  the  fore- 
head, with  an  aperature  in  the  midldle,  through  which  the  operator  may 
look.  This  reflects  the  light,  and  reveals  the  interior  of  the  canal.  In 
looking  into  the  external  ear  you  may  notice  that  there  is  too  much  or 
too  little  wax,  indicating  some  general  disease.  You  may  notice  that  there 
are  growths  in  the  ear,  or  foreign  bodies,  such  as  buttons  in  children's  ears, 
or  insects,  or  the  wax  may  become  hard  and  impacted.  1  had  a  case  once 
in  which  a  person  had  noticed  a  slight  deafness,  continually  increasing 
until  finally  he  was  not  able  to  hear  his  watch  tick  when  held  at  his  ear. 
I  found  by  examination  that  the  wax  had  become  impacted.  Of  course 
he  could  hear  internally  by  certain  methods  employed  to  test  the  hearing. 
I  took  the  curved  end  of  a  hair  pin  and  picked  out  the  wax,  and  he  could 
hear  all  right.  It  is  quite  a  common  thing  in  persons  who  have  a  poor 
quality  of  blood  to  have  furuncles,  or  boils,  in  the  external  auditory  canal. 
Your  examination  of  the  ear  will  reveal  to  you  the  inenibrana  tyinpani, 
which  should  appear  concave.  It  is  in  color  a  pearly  gray  and  glistens 
with  the  reflection  of  the  light.  You  can  see  the  processus  brevis  of  the 
malleus  and  the  manubrium  of  the  malleus,  and  you  can,  sometimes,  with 
a  good  light,  see  the  processus  longus  of  the  incus.  The  membrane  appears 
concave,  the  most  concave  part  is  at  the  end  of  the  manubrium,  at  the 
tip  of  the  manubrium  appears  a  bright  triangle  or  pyramid  of  light  where 
the  reflection  is  brighter  than  at  other  parts,  this  cone  of  light  is  called 
the  umbo.  Only  practice  will  make  you  familiar  with  the  normal  external 
parts  and  appearance  of  the  membrane.  Further,  you  should  always  in 


121  TREATMENT   OF   THE   EAR   AND   NOSE. 

examining  the   ear  look  for  perforations  of  the  membrane  because  those 
frequently  occur  in  ear  troubles. 

As  to  the  MIDDLE  EAR,  you  may  have  it  affected  by  different  diseases, 
among  which  are  inflammations,  catarrh,  etc.,  in  which  case  pus  or  mucus 
may  collect  in  it.  In  that  case,  the  membrane  would  be  pushed  outward, 
and  would  be  convex  instead  of  concave.  By  examining  from  the  ex- 
ternal ear,  if  inflammation  were  present  there  would  be  a  reddish  appear- 
ance of  the  membrane.  It  is  said  the  presence  of  mucus  or  pus  gives  a 
yellowish  tinge  to  the  membrane.  For  examination  to  see  whether  or 
not  the  Eustachian  tube  be  closed  there  are  different  methods  used.  One 
is  for  the  patient  to  close  his  nose  and  mouth  and  make  an  expiratory 
effort,  eliciting  a  crackling  sound  of  the  membrane,  due  to  the  impact  of 
the  air.  That  is  called  Valsalva's  method.  Another  method,  called  Polit- 
zer's,  is  practically  the  same.  The  patient  is  directed  to  swallow  a  little 
water,  the  operator  having  introduced  a  tube  through  one  nostril,  and 
closing  the  mouth  and  both  nostrils  except  the  tube;  through  this  tube 
the  operator  blows,  and  the  air  is  forced  up  toward  the  membrane,  and 
in  case  the  membrane  is  perforated  there  is  a  whistling  sound  as  the  air 
•  escapes,  or  if  there  is  an  accumulation  of  pus  or  fluids,  they  will  be 
driven  into  the  external  ear.  In  case  of  closure  of  the  external  ear  it  is 
said  that  there  is  a  magnification  of  the  sound  in  the  middle  ear,  or  in 
case  of  closure  of  the  Eustachian  tube  the  same  thing  would  obtain,  or 
in  case  there  was  too  much  secretion  about  the  ossicles,  not  allowing 
free  motion.  In  such  cases  a  tuning-fork  held  against  the  teeth  causes  the 
sound  to  be  increased  in  the  affected  side.  If  it  is  heard  louder  in  the  other 
ear,  it  indicates  some  trouble  with  the  internal  ear  of  the  affected  side. 
Your  diagnosis  may  be  made  still  closer  by  placing  a  watch  or  tuning  fork 
against  the  mastoid  process  of  the  affected  ear;  if  there  is  no  response 
you  may  be  sure  the  trouble  is  in  the  internal  ear.  Those  are  a  few 
methods  by  which  you  may  determine  where  is  the  trouble  that  is  affect- 
jn  the  ear.  Since  the  aurist  makes  the  ear  his  life  time  work,  we  cannot 
do  justice  to  the  subject  in  any  one  or  two  lectures. 

*IV.  TREATMENT  OF  THE  EAR.— I  have  already  shown  you 
how  to  examine  the  external  canal  of  the  ear;  the  usual  methods  are  em- 
ployed to  remove  foreign  substances,  or  in  case  of  impacted  wax  you  had 
better  use  some  warm  water;  it  may  take  several  sittings  to  remove  it 
entirely,  and  the  hearing  may  be  worse  after  the  first  treatment  with  the 
water  because  of  the  swelling  of  the  wax  filling  the  canal.  In  the  case 
of  insects  in  the  ear,  warm  water  or  sweet  oil  may  be  introduced  with  a 
syringe.  In  ear  affections  there  is  usually  trouble  with  the  atlas  or  in  the 
upper  cervical  region.  We  treat  the  lesion  if  we  find  it,  in  the  neck,  and 


"See  Appendix  \2. 


TREATMENT   OF   NOSE   AND   THROAT.  125 

we  treat -the  ear  largely  by  regulating  the  blood  supply;  by  springing  the 
jaw,  as  already  shown.  The  chief  work  in  the  neck  is  on  the  superior  cer- 
vical ganglion,  and  in  stimulating  the  blood-flow  through  the  carotid  ar- 
teries. In  affections  of  the  ear  from  catarrli  or  constitutional  troubles 
you  would  have  to  direct  your  treatment  to  the  general  condition  of  the 
patient.  I  had  an  interesting  case  of  deafness  once,  where  1  did  not  treat 
the  ear  at  all.  I  found  the  clavicle  was  slipped;  that  the  scaleni  muscles 
were  hard;  that  there  was  a  paresis  of  the  right  arm.  I  slipped  the 
clavicle  back,  treated  the  scaleni  muscles,  and  the  lady  went  up  stairs  and 
immediately  called  down  that  she  could  hear  the  clock  ticking  down 
stairs,  something  she  had  not  done  before.  It  must  have  been  by  sympa- 
thetic connection  of  the  nerves  which  had  been  affected;  the  brachial 
plexus  and  the  nerves  to  the  ear.  I  do  not  know  of  any  other  way  to 
account  for  it.  That  shows  you  cannot  always  work  according  to  rule, 
but  you  must  look  for  the  cause  and  treat  wherever  that  may  occur. 

EXAMINATION  AND  TREATMENT  OF  THE  NOSE  :— Since  the 
aperture  of  the  nostril  is  on  a  little  lower  level  than  the  bottom  of  the  pass- 
age of  the  nostril,  you  have  to  draw  the  nose  up  and  back.  You  can  dilate 
it  with  a  speculum  used  for  the  purpose,  and  you  can  use  either  form  of 
reflected  light.  You  may  see  the  middle  and  inferior  turbinated  bones  and 
the  marks  I  have  mentioned.  You  will  learn  to  recognize  the  normal 
conditions,  and  to  note  any  diseased  conditions  and  observe  whether  there 
are  any  growths  in  the  nose ;  the  polypus  is  the  most  common. 

It  is  common  to  meet  with  fractured  nasal  bones.  That  belongs  to 
the  surgeon,  but  is  very  readily  set.  You  can  diagnose  this  condition  by 
holding  the  ear  close,  and  you  can  hear  a  grating  sound  as  you  move 
the  nose.  I  have  had  cases  in  which  I  would  straighten  out  the  parts, 
using  no  splint  or  anything  of  that  kind.  With  no  splints  the  bones  will 
stay  in  position  and  no  deformity  follow.  You  will  sometimes  notice  that 
in  catarrh,  on  account  of  the  absorption  of  these  turbinated  bones,  the 
nose  is  deflected  to  one  side  or  to  the  other.  The  usual  way  in  which 
we  treat  the  nose,  aside  from  the  general  system  which  is  adopted  in 
catarrh,  the  freeing  of  the  blood-supply  in  the  neck  and  of  the  blood- 
supply  about  the  nose,  is  to  work  on  the  outside  of  the  nose  and  loosen 
all  the  tissues  along  the  side.  In  that  way  also  you  free  the  nasal  duct 
by  loosening  all  the  tissues.  Also,  in  case  of  stoppage  of  the  nose  in 
colds  and  catarrh,  we  place  the  hand  flat  above  the  frontal  sinuses  and 
press  down  quite  hard.  You  can  sometimes  clear  the  nostrils  in  that 
way  so  that  the  stoppage  is  gone  and  the  breathing  is  clear  through  the 
nostrils.  There  is  another  disease  which  you  frequently  meet,  a  ringing 
in  the  ear,  tinnitus  aurium.  It  is  common  in  old  people,  and  it  is  com- 
mon also  in  constitutional  diseases,  after  sunstroke,  or  in  malnutrition, 
and  old  age.  Therefore,  it  arises  sometimes  from  conditions  of  general 


126  TREATMENT   OF   THE   THROAT. 

health.  The  Osteopath  has  found  that  it  is  due,  in  some  cases,  to  a 
stoppage  of  the  circulation  in  the  little  anastomosis  on  the  ear-drum,  and 
he  then  works  in  the  usual  method  to  free  the  carotid  artery,  and  by 
stretching  the  jaw.  Sometimes  the  trouble  is  in  an  obstruction  to  the 
auditory  nerve.  It  is  said  that  we  inhibit  the  auditory  nerve  by  pressure 
in  the  neck  opposite  the  third  cervical,  by  steadily  holding  there. 

I  cannot  mention,  in  such  a  lecture  as  this,  all  the  points  in  connection 
with  examination  of  the  MOUTH  AND  THROAT.  That  also  is  a  field  for  the 
specialist.  I  have  noted  that  you  should  see  the  condition  of  the  tongue, 
whether  it  is  furred,  what  its  temperature  is,  and  its  color.  These  are 
very  indicative.  For  instance  it  is  said  a  tongue  furred  on  one  side  is 
indicative  of  a  one-sided  disease,  as  of  the  liver  or  spleen.  A  furred  tongue 
has  been  noticed  by  Hilton  in  a  case  of  ulceration  of  the  teeth.  The  half  of 
the  tongue  on  the  side  of  the  mouth  affected  by  the  tooth  was  furred, 
and  there  was  stiffness  of  the  jaw.  He  referred  it  to  the  fifth  nerve, 
which  supplies  the  muscles  of  the  jaw  and  supplies  also  a  part  of  the 
tongue.  As  to  the  color  of  the  tongue,  we  might  mention,  for  instance, 
the  strawberry  tongue,  as  it  is  called,  in  scarlet  fever,  or  the  lead  colored, 
thrush-covered  tongue  in  the  dying. 

You  will  observe  the  TONSILS,  the  UVULA,  and  the  condition  of  the 
FAUCES.  Frequently  in  diseases  of  the  throat  the  uvula  is  inflamed  or 
edematous,  and  is  hanging  down,  obstructing  the  passage  of  the  air,  and 
keeping  the  patient  continually  coughing.  There  are  certain  times  when 
we  give  internal  treatment  to  the  mcuth  and  throat,  but  not  very  fre- 
quently. That  is,  in  case  of  catarrh,  tonsilitis,  or  something  of  that  kind. 
We  insert  the  fingers,  and  by  a  pressure  upward  and  outward  along  the 
pillars  of  the  fauces,  free  the  circulation  to  those  parts,  and  in  that  way, 
to  a  considerable  extent,  allay  the  inflammation.  That  is,  we  frequently 
relax  congested  and  contracted  parts.  The  general  treatment  for  the 
throat  I  have  shown  you,  by  loosening  the  muscles  and  by  working  to 
free  the  blood-supply,  but  you  must  also  be  sure  that  all  the  muscles 
throughout  the  neck  are  relaxed.  You  can  feel  those  in  the  back  of  the 
neck,  as  I  have  already  shown.  You  cannot,  however,  feel  the  anterior 
spinal  muscles  in  the  neck,  you  must  take  into  consideration  the  prob- 
ability that  where  others  are  contracted,  they  also  are,  and  adapt  your 
different  motions  to  the  stretching  of  those  muscles;  simply  by  stretching 
the  head  backward  you  can  free  all  the  branches  of  the  nerves  by  relax- 
ing the  muscles. 

There  is  a  great  deal  more  that  might  be  said,  both  in  general  and 
in  particular,  concerning  the  eye,  nose,  throat,  and  parts  of  the  head,  but 
I  think  that  in  three  lectures  that  I  have  given  you  I  have  been  able 
to  give  you  the  usual  Osteopathic  treatment  for  the  parts  of  the  head, 
and  to  give  a  general  idea  of  the  importance  of  these  things.  Of  course 


THE   SPLANCHNIC    NERVES.  127 

we  depend  entirely  upon  the  nerve  and  blood  supply.  That  is  the  chief 
part  of  the  work. 

Q.  In  regard  to  examination  of  the  nostril,  you  said  we  should 
observe  the  turbinated  bones.  Is  there  any  way  by  which  you  can  re- 
move abnormal  growths  from  that  bone  Osteopathically  ? 

A.  That  bone  is  very  frequently  softened  by  catarrh,  sometimes 
ulcerated  and  eaten  away,  and  in  so  far  as  you  can  influence  catarrh, 
with  which  we  have  good  results,  you  could  influence  this  other  trouble, 
and  by  work  upon  the  nose  you  might  gradually  restore  the  parts  to  their 
normal  condition. 

Q.  You  spoke  of  dropping  of  the  uvula,  is  that  not  caused  largely 
by  catarrh? 

A.  Yes,  sir,  in  general.  Anything  which  would  inflame,  of  which 
catarrh  is  an  example. 


LECTURE  XIX. 

At  the  eighteenth  lecture  I  considered  certain  Osteopathic  points 
about  the  head,  giving  you  certain  centers  for  the  head  and  its  parts, 
which  I  need  not  repeat  here;  something  concerning  the  vaso-motors, 
that  the.  Osteopath  had  therefore  a  good  field  upon  which  to  work  in 
treating  the  head  and  all  its  parts,  the  brain  included.  I  then  instanced 
certain  landmarks,  and  took  up  further  the  subject  of  how  to  examine 
the  parts  of  the  head,  including  the  eye,  nose,  throat  and  mouth.  I 
wish  to-day  to  call  your  attention  further  to  the  thorax  and  its  parts. 
We  have  so  far  in  our  Osteopathic  work  seen  how  to  examine  the  spine, 
neck,  head,  etc. ;  the  significance  of  points  discovered ;  also  how  to  treat 
them.  It  is  of  great  interest  to  us  now  to  go  to  the  THORAX.  And  in  go- 
ing to  the  thorax  it  is  quite  fitting  that  I  should  say  something  in  particu- 
lar about  the  splanchnic  nerves.  I  have  already  said  something  concerning 
these  nerves,  but  think  something  more  in  particular  would  be  of  value 
to  you.  The  splanchnics  are  some  of  the  most  important  tools  with 
which  the  Osteopath  works,  and  I  will  venture  the  assertion  that  there 
will  be  hardly  a  day  in  your  practice  pass  without  your  working  upon 
the  splanchnics.  They  are  of  such  far  reaching  connection  that  their 
importance  at  once  becomes  apparent,  hence  their  constant  use  by  the 
Osteopath.  As  to  definition,  you  know  what  splanchnology  is — the  science 
of  the  viscera.  Hence,  the  splanchnics  refers  to  visceral  nerves,  those 
nerves  governing  the  viscera,  and  it  is  in  this  fact  that  their  significance 
lies.  It  is  with  the  sympathetic  splanchnic  nerves  that  we  as  Osteopaths 
have  to  deal,  and  it  is  because  of  their  far  reaching  control  of  visceral 
life  and  the  wonderful  results  the  Osteopath  can  get  in  working  upon 


128  THE   SPLANCHNIC   NERVES. 

them,  that  he  has  been  so  successful  in  treatment  of  diseases  in  general. 
That  is  one  of  th~  reasons,  I  should  say. 

Now,  as  to  what  these  nerves  are,  we  know,  at  once  that  they  are 
the  sympathetics  from  the  lateral  chains  of  thoracic  ganglia.  I  want  to 
bring  out  a  few  points  concerning  these  nerves  by  way  of  review,  so  that 
we  will  know  what  we  are  working  with.  First  the  great  splanchnic 
arises  from  as  high  as  the  fifth  or  sixth,  and  from  all  of  the  thoracic 
ganglia  below  down  to  the  ninth  or  tenth.  It  perforates  the  diaphragm 
and  joins  the  lower  part  of  the  semi-lunar  ganglion.  In  the  chest  it 
sometimes  divides  and  forms  a  plexus  with  the  smaller  splanchnic.  As 
to  the  nature  of  these  fibres,  they  are  white,  medullated  fibers.  You 
remember  in  one  of  the  first  lectures  I  called  your  attention  to  the  fact 
that  in  the  sympathetic  there  are  two  kinds  of  fibers.  It  is  stated  by 
Quain  that  about  four-fifths  of  the  fibers  of  the  splanchnics  are  made 
up  of  white,  medullated  fibers,  and  they  come  direct  from  the  anterior 
roots  of  the  spinal  nerves.  This  greater  splanchnic  may  arise  as  high 
as  the  third  thoracic.  Gray  states  it  may  receive  branches  from  the 
upper  six  thoracic.  This  greater  splanchnic  gives  branches  to  the  aorta 
and  to  the  front  of  the  vertebrae. 

The  smaller  splanchnic  arises  from  the  ninth  and  tenth,  as  usually 
described,  sometimes  from  the  tenth  and  eleventh,  thoracic  ganglia. 
Or,  it  may  not  arise  from  the  ganglia,  it  may  arise  from  the  sympathetic 
cord  itself  without  the  intervention  of  ganglia.  It  also  passes  through 
the  diaphragm,  sometimes  separately,  sometimes  in  conjunction  with 
the  cord  of  the  greater  splanchnic.  Like  the  greater  splanchnic,  it  joins 
the  lower  part  of  the  semi-lunar  ganglion,  and  sends  branches  to  the 
renal  plexus  in  case  the  renal  splanchnic  is  wanting,  or  is  small. 

The  smallest,  or  renal  splanchnic,  as  you  gather  from  the  above,  is 
sometimes  wanting.  It  arises  from  the  last  thoracic  ganglion,  and  passes 
through  the  diaphragm  in  connection  with  the  sympathetic  cord,  and 
goes  to  the  renal  plexus,  not  the  semi-lunar  ganglion. 

A  fourth  splanchnic  is  sometimes  described.  It  is  stated  that  Wrisberg, 
in  eight  instances  out  of  a  great  many,  found  a  fourth  splanchnic  in  the 
cervical  region. 

We  all  understand  what  is  meant  when  we  speak  of  the  splanchnics. 
That  is,  these  three  splanchnic  nerves.  But  you  will  see  that  it  is 
sometimes  used  in  a  different  sense.  Gaskell,  quoted  by  Quain,  says  that 
there  are  visceral  branches  from  the  second,  third  and  fourth  sacral 
nerves,  and  these  he  calls  the  "sacral  or  pelvic  splanchnics."  "The  cervico- 
cranial  rami  viscerales"  are  visceral  branches  from  the  spinal  accessory, 
pneumogastric,  glosso-pharyngeal  and  facial  nerves.  So  you  see  that 
visceral  nerves  have  their  origin  from  these  cranial  nerves;  also  a  branch 
from  the  ciliary  ganglion  from  the  third  nerve.  Byron  Robinson  has 


REGULATIVE   EFFECTS   OF    WORK    UPON   THE   SPLANCHNICS.  129 

this  to  say  concerning  splanchnics  in  general:  "There  £.re  certain  fine 
white  medullated  nerves,  which  Gaskell  mentioned,  and  which  pass  from 
the  spinal  cord  in  the  white  rami  communicantes  between  the  second 
dorsal  and  second  lumbar  nerves  inclusively,  to  supply  viscera  and  blood 
vessels.  These  nerves  should  be  called,  as  Gaskell  suggests,  splanchnics. 
Hence,  we  will  have,  first,  the  thoracic  splanchnics ;  second,  the  ab- 
dominal splanchnics,  and  third,  the  pelvic  splanchnics."  Hence,  you 
will  see  the  general  use  to  which  Gaskell  put  the  term,  in  the  use  of 
which  the  other  authorities  have  concurred.  Robinson  says  further,  that 
these  white  rami  communicantes  extend  from  the  second  dorsal  to  the 
second  lumbar,  but  we  know  that  along  this  region,  and  in  the  region 
above  the  second  dorsal  and  below  the  second  lumbar,  gray  ones  are 
found.  In  the  last  two  named  regions,  gray  exclusively.  That  variety 
he  calls  peripheral,  supplying  the  parities  of  the  body.  From  the  fore- 
going, and  what  has  been  said  in  general  concerning  splanchnics,  we 
see  that  the  splanchnics  proper  of  which  we  speak,  are  white  medullated 
fibers,  for  the  most  part,  and  that  their  particular  function  is  to  attend 
to  the  blood  vessels  and  to  the  viscera. 

Flint  says  that  the  splanchnics  are  the  most  important  vaso-motors 
of  the  system.  And  further,  Quain  states  that  the  medullated  fibers,  that 
is,  such  as  we  find  in  the  splanchnics,  which  pass  in  the  sympathetic 
system,  are  classed  by  Kolliker  as;  (a)  sensory,  (b)  vaso-  and  viscero- 
constrictors,  and  (c)  vaso-  and  viscera-inhibitors.  Hence,  we  have  passing 
from  the  spinal  cord  into  the  great  prevertebral  plexuses  in  the  different 
regions  these  sensory,  vaso-dilator  and  constrictor,  and  viscero-inhibitor 
and  constrictor  fibres.  He  goes  on  to  say  that  the  sensory  are  found 
only  passing  from  the  cranial  nerves,  but  that  the  visceral  and  vaso- 
motor  fibers  are  found  all  the  way  down  the  cord.  Hence  we  see  at 
once  that  these  visceral  and  vaso-motor  fibers  are  found  in  the  splanch- 
nics. In  line  with  the  above,  Quain  says  further,  that  the  splanchnic 
nerves  proper  act  first,  as  viscero-inhibiiory  fibers  for  the  stomach  and 
intestines;  second,  as  vaso-motor  fibers  to  the  abdominal  blood  vessels; 
third  as  afferent  fibers  from  the  abdominal  viscera,  that  is,  fibers  from 
the  abdominal  viscera  back  to  the  center.  That  explains  why  it  is  that 
we  get  secondary  lesions,  as  we  call  them.  You  may  have  some  trouble 
in  a  viscus,  and  knowing  that  you  have  afferent  fibers  from  the  viscus 
to  the  center,  you  can  account  for  the  center  being  affected  and  the 
impulse  coming  out  from  it  to  the  posterior  spinal  nerves,  for  example, 
and  causing  contracture  of  the  muscles  in  the  back. 

I  have  already  said  enough  to  show  you  the  importance  of  the 
splanchnics — to  show  you  in  general  their  nature  and  function.  They 
become  still  more  significant  to  the  Osteopath  when  he  considers  their 
connections  with  the  other  parts  of  the  sympathetic  system.  In  the  first 


130  REGULATIVE   EFFECTS   OF    WORK    UPON    THE    SPLANCHNICS. 

place,  they  must  be  connected  with  the  spinal  cord  itself,  since  they  arise 
from  the  anterior  roots,  and,  through  the  cord,  with  the  brain.  It  is 
doubtful  how  close  a  connection  they  have  with  the  brain  centers,  but  they 
have  at  least  a  close  connection  with  the  bulbar  center,  the  vaso-con- 
strictor  center  of  the  medulla.  Then  it  is  probable  that  these  splanchnics 
have  a  close  connection  also  with  cardiac  and  pulmonary  fibers  arising 
from  the  upper  part  of  the  spinal  cord,  because  we  have  seen  that  the 
center  for  the  lungs  extends  from  the  second  to  the  seventh  dorsal,  and 
that  we  work  in  the  upper  dorsal  region  for  the  heart,  and  there  are 
certain  vaso-motor  fibers  from  these  regions  to  the  heart  and  lungs,  so 
that  it  is  almost  indisputable  that  there  is  a  connection  between  the 
splanchnics  and  what  we  might  call  other  splanchnics  for  the  heart  and 
lungs.  Tn  the  next  place,  we  have  seen  that  the  first  two  splanchnic 
nerves  join  the  semi-lunar  ganglion,  and  the  third  the  renal  ganglion. 
And  they  are  connected  directly  with  the  solar  plexus,  and  through  it 
with  the  other  great  prevertebral  plexus,  the  hypogastric  plexus,  and 
through  that  with  those  secondary  plexuses,  such  as  the  superior 
and  inferior  mesenteric,  hemorrhoidal,  portal,  Auerbach's  and  Meissner's, 
and  the  various  plexuses  throughout  the  pelvis  and  elsewhere.  Hence, 
anyone  who  sees  the  significance  of  Osteopathic  work  will  see  the  sig- 
nificance of  this  far  reaching  connection  with  visceral  and  organic  life. 
Then  again,  remember  that  in  the  thorax  the  first  or  greater  splanchnic 
sends  branches  directly  to  the  aorta  itself.  Hence  it  is  that  the  operator 
so  frequently  works  upon  the  splanchnics.  It  does  not  make  any  differ- 
ence what  kind  of  trouble  you  may  have,  the  general  health  is  likely 
to  be  affected,  and  it  must  be  attended  to;  and  whether  you  are  working 
upon  the  stomach,  liver,  portal  system,  upon  the  intestines,  or  pelvic 
viscera,  you  will  work,  at  least  in  part,  upon  the  splanchnics. 

There  is  a  setond  sense  in  which  we  must  consider  the  use  of  these 
splanchnic  nerves,   and  we  may   state  the   matter  this  way;   That  WORK 

UPON    THE    SPLANCHNIC    NERVES    IS    FREQUENTLY    A    REGULATIVE     PROCESS.       J 

might  illustrate  what  I  mean.  Here  you  have  a  lot  of  sympathetic  nerves, 
they  are  vaso-motor  nerves  for  very  important  parts  of  the  body,  viz.,  the 
internal  viscera,  which  receive  an  exceedingly  large  blood-supply.  If  the 
Osteopathic  ability  to  work  upon  the  nerve  centers  and  nerve  connections 
stands  for  anything,  it  must  certainly  stand  for  something  when  it  goes 
to  work  upon  these  splanchnics.  Hence,  he  must  have  a  large  control 
throughout  a  great  portion  of  the  circulation  of  the  body,  since  it  is  so 
richly  supplied  from  these  nerves.  Here  you  have  a  quantity  of  blood  in 
the  body;  we  will  say  in  a  certain  case  it  is  unequally  divided.  The 
Osteopath's  work  is  sometimes  to  equalize  the  circulation  throughout 
the  body.  In  case  you  have  a  headache,  which  is  frequently  a  congestion 
in  the  cranium,  what  do  you  wish  to  do?  You  wish  to  regulate  the  circu- 


REGULATIVE   EFFECTS   OF    WORK    UPON    THE   SPLAN  CHNICS.  131 

lation.  You  must  therefore  employ  some  regulative  process,  and  very 
frequently  we  work  upon  these  splanchnics  to  throw  this  congestion 
somewhere  else  where  it  will  do  no  harm.  Another  thing,  the  most 
natural  place  for  the  overplus  of  blood  to  go  is  into  the  abdominal  veins. 
Green  makes  the  statement  that  the  abdominal  veins  are  the  most  easily 
dilated,  and  while  I  cannot  exactly  quote  from  him,  I  believe  he  goes 
on  to  say  that  the  overplus  of  blood  is  most  readily  thrown  there.  At 
any  rate  I  can  state  it  is  my  experience  that  we  can  get  important  results 
by  throwing  the  congested  blood  to  the  abdominal  veins,  and  we  do 
cause  another  congestion  there.  Not  long  ago  I  had  a  case  of  headache: 
it  came  from  prolapsus  uteri.  The  lady  had  vomited,  and  had  had  trouble 
with  her  stomach.  I  gave  the  usual  treatments,  as  I  always  do  first, 
working  about  the  region  of  the  stomach  and  liver,  and  over  the  splanch- 
nics, as  it  looked  as  if  the  case  at  first  might  ibe  a  case  of  sick  headache, 
later  she  told  me  it  was  from  prolapsus.  I  then  treated  all  about  her 
head,  but  the  headache  did  not  go  until  I  finally  pressed  deeply  over  the 
region  of  the  solar  plexus.  By  deep  pressure  there  until  you  can  feel 
the  pulsation  of  the  abdominal  aorta,  you  will  get  important  results.  In 
other  cases  I  have  relieved  headache  by  simply  pressing  there.  Now. 
whether  there  was  simply  inhibition  over  the  solar  plexus,  and  thus  to  the 
brain,  and  thus  quieting  the  painful  senses,  I  could  not  say,  but  it  seems 
to  me  more  likely  that  it  was  a  regulative  process  which  inhibited  the 
solar  plexus  and  allowed  the  blood  to  come  to  the  veins  of  the  abdomen, 
and  thus  relieved  the  congestion  in  other  parts.  There  is  another  thing 
that  I  frequently  notice  in  my  practice,  that  is,  I  get  effects  upon  the  cir- 
culation of  the  body  by  a  general  spinal  treatment,  which  of  course  in- 
volves work  upon  the  splanchnic  region.  And  I  can,  by  working  there, 
coupled  with  the  usual  treatment  I  give  the  heart,  get  better  results  in 
quieting  the  pulse  than  I  can  by  other  methods.  It  seems  to  me  it  is 
because  I  get  a  dilation  of  the  vessels  throughout  the  abdominal  viscera, 
hence  lessening  of  the  tension,  slowing  of  the  blood-flow  follows,  and 
a  quieting  of  the  pulse.  A  case  of  the  same  kind  might  toe  mentioned 
where  a  congested  uterus  was  relieved  by  work  over  the  splanchnic 
region.  How  we  reach  and  treat  that  region  I  will  show  you  in  detail 
in  the  third  part  of  the  lecture. 

In  line  with  what  I  have  stated,  Howell's  Text  Book  says  that,  "vas- 
cular changes  produced  reflexly  in  the  splanchnic  area  are.  of  especial 
importance  because  of  tl.e  great  number  of  vessels  innervated  through 
these  nerves,  and  the  great  changes  in  blood  pressure  that  can  follow 
dilation  or  constriction  on  so  large  a  scale."  Some  one  asked  me  some 
time  ago  how  we  worked  to  cure  a  cold.  I  told  him  that  was  a  matter 
of  general  treatment  which  I  shall  take  up  later.  However,  we  give  a 
spinal  treatment,  drawing  the  congestion  from  the  part  affected,  which  is 


132  LANDMARKS. 

very  frequently  the  head,  and  give  relief.  That  is,  we  work  upon  a  large 
amount  of  blood  controlled  by  the  splanchnics,  and  thus  draw  it  away 
from  the  congested  part.  ~We  thus  see  that  it  is  a  very  probable,  and,  in 
view  of  the  facts  it  is  quite  likely  the  case,  that  the  Osteopath  can  almost 
at  will  throw  large  quantities  of  blocd  to  the  abdominal  region,  or  away 
from  it,  by  proper  treatment.  I  might  state  in  passing  that  it  is  a  prin- 
ciple of  which  we  might  take  notice,  that  in  a  case  of  congestion  it  is  a 
good  plan  to  divert  the  congestion  to  some  other  part  where  it  will  do  no 
harm.  We  stated  the  other  day  when  the  matter  was  brought  up  that 
the  way  to  treat  it  was  to  sweep  it  out  by  freeing  the  arterial  blood  flow 
to  the  part.  I  am  indebted  to  Dr.  Conner  for  the  suggestion  that  ft  is 
well  to  divert  the  congestion  to  a  part  where  it  will  do  no  harm.  I  saw 
him  treat  a  case  some  time  ago,  an  old  lady  with  a  very  troublesome  cold 
in  her  head,  which  gave  her  headache  and  caused  her  a  great  deal  of 
trouble.  She  had  been  treated  for  bronchial  trouble,  the  pain 
had  left  the  upper  part  of  the  chest,  and  she  thought  the  congestion  had 
been  forced  into  the  head.  Several  had  treated  the  case  unsuccessfully. 
Dr.  Conner  raised  the  clavicle  and  treated  the  circulation  to  the  arm.  I 
asked  him  about  it.  He  said,  "I  just  lifted  that  clavicle  and  sent  the  con- 
gestion down  the  arm  where  it  would  do  no  harm."  I  think  we  very  fre- 
quently use  that  method  and  throw  the  blood  somewhere  else,  but  when 
it  is  thrown  somewhere  else  I  do  not  believe  it  is  congestion.  Howell's 
Text  Book  says  further,  "Anemia  or  asphyxia  of  the  brain  stimulates  the 
cells  composing  the  center,  that  is  the  vaso-motor  center,  and  more  blood 
enters  the  cranial  cavity  where  it  is  needed.  Doubtless  the  splanchnic 
area  plays  an  important  part  in  this  restoration  process."  Hence  we  see 
from  that,  in  the  first  place  that  the  Osteopath  may,  by  his  appropriate 
methods,  influence  the  blood  in  the  splanchnic  area  by  work  upon  the 
vaso-motor  area  in  the  medulla.  And  since  it  is  a  poor  rule  that  will  not 
work  both  ways,  he  can  do  the  reverse,  that  is,  he  can  affect  blood-flow 
in  the  head  by  work  upon  the  splanchnics  directly.  Our  conclusions  may 
be  expressed  under  two  heads,  first,  that  in  work  upon  the  splanchnics  the 
Osteopath  works  upon  them  for  the  effect  that  he  produces  upon  the  con- 
nected viscera  supplied  by  those  splanchnics.  That  he  works  upon  them 
in  a  secondary  manner,  frequently,  for  regulation  of  blood  currents  to  the 
body  generally,  or  in  some  particular  part  of  the  body.  - 

II.  LANDMARKS:— (According  to  Hoi  den:)  Since  the  heart  and 
lungs  are  contained  in  the  thorax,  and  since  abnormalities  of  the  parts  of 
the  thorax  may  cause  serious  troubles  with  these  important  viscera,  and 
since  the  Osteopath  finds  so  many  things  upon  which  to  work  about  the 
thorax,  I  hardly  need  to  say  to  you  that  it  is  important  that  we  know  the 
landmarks  of  the  thorax  thoroughly.  I  have  given  you  some  in  connection 
with  the  spine,  but  you  will  notice  the  following :  As  a  rule  the  right  side 


EXAMINATION    OF    THE    THORAX.  133 

of  the  chest  is  a  little  larger  than  the  left,  and  you  should  bear  that  in  mind 
in  making  your  examination.  In  the  female  the  sternum  is  shorter  and  the 
upper  ribs  are  more  movable.  The  upper  aperture  of  the  thorax  is  on  a 
levelwith  the  second  dorsal  vertebra,  is  quite  narrow,  rarely  exceeding  two 
inches.  Behind  the  first  bone  of  the  sternum  there  is  no  lung  tissue.  The 
left  vena  innominata  crosses  behind  the  sternum  about  an  inch  below  the 
top.  Next  come  the  great  primary  branches  from  the  aorta.  You  get, 
deeper  in  this  region,  the  bifurcation  of  the  trachea  at  about  the  level  of 
the  junction  of  the  first  and  second  parts  of  the  sternum ;  and  deepest  of 
all  lies  the  oesophagus.  On  the  bifurcation  of  the  trachea,  and  about  an  inch 
below  the  upper  margin  of  the  sternum,  lies  the  highest  part  of  the  arch 
of  the  aorta,  which  curves  over  the  left  bronchus.  The  course  of  the 
innominate  artery  corresponds  to  a  line  drawn  from  the  middle  of  the 
junction  of  the  first  and  second  bones  of  the  sternum  to  the  right  sterno- 
clavicular  articulation.  All  these  are  interesting  to  know.  Here  is  some- 
thing that  is  absolutely  essential  to  know. 

RULES  FOR  COUNTING  THE  RIBS  ;  In  passing  your  fingers  down  the 
sternum  in  front  you  can  readily  detect  where  the  first  part  ends  and  the 
second  part  begins.  Here  is  the  junction  of  the  cartilage  of  the  second  rib 
with  the  sternum.  The  first  rib  is  found  by  feeling  behind  the  clavicle 
above,  at  about  the  junction  of  the  middle  and  inner  thirds.  You  can  by 
deep  pressure  come  to  the  first  rib.  The  first  and  second  ribs  give  a  great  deal 
of  trouble,  and  it  is  important  to  keep  in  mind  this  rule  to  find  them. 
In  the  male  the  nipple  is  usually  between  the  third  and  fourth  ribs,  three 
quarters  of  an  inch  external  to  the  line  of  their  cartilages.  It  is  said  that 
the  lower  external  border  of  the  pectoralis  major  corresponds  in  direction 
with  the  fifth  rib,  that  a  horizontal  line  drawn  from  the  nipple  around 
the  body  will  cut  the  sixth  intercostal  space  at  a  point  midway  between  the 
sternum  and  the  spine.  When  the  arm  is  raised  the  highest  visible  digita- 
tion  of  the  serratus  magnus  corresponds  with  the  sixth  rib,  and  the  seventh 
and  eighth  digitations  correspond  with  the  seventh  and  eighth  ribs  below. 
I  have  already  noted  that  the  scapula  lies  on  the  ribs  from  the  second 
to  the  seventh  inclusive.  The  eleventh  and  twelfth  ribs  are  readily  recog- 
nized, even  in  fleshy  persons,  at  the  outer  edge  of  the  erector  spinje,  slop- 
ing downward.  The  sternal  end  of  each  rib  is  lower  than  the  end  which 
joins  the  spine,  and  it  is  said  that  if  a  horizontal  line  were  drawn  from  the 
middle  of  the  third  costal  cartilage  at  its  junction  with  the  sternum,  it 
would  touch  the  body  of  the  sixth  dorsal  vertebra.  The  end  of  the  stern- 
um is  upon  a  level  with  the  tenth  dorsal  vertebra,  its  length  varying  some 
in  different  individuals,  more  in  females  than  in  males. 

III.  (a)  HOW  TO  TREAT  THE  SPLANCHNICS.  (b)  HOW 
TO  EXAMINE  THE  THORAX:— There  are  various  ways  in  which 
we  may  treat  the  splanchnics.  One  of  the  best  ways  to  treat  them,  espe- 


134  EXAMINATION    OF   THE  THORAX. 

daily  the  renal  splanchnic,  is  to  have  the  patient  on  the  back,  everything 
being  relaxed.  If  you.  are  afraid  that  the  psoas  muscles  will  not  be  re- 
laxed, you  can  flex  the  limbs.Then,  by  reaching  under,  by  thrusting  in 
one  hand  from  each  side,  and  raising  the  patient  on  the  tips 
of  the  fingers,  we  get  one  of  the  most  important  effects  upon 
the  splanchnics.  Dr.  Harry  Still  treats  in  that  way  almost  entirely 
for  the  kidneys.  We  may  also  treat  the  ?planchnics  by  having  the 
patient  on  the  side  and  springing  the  spine  all  along  the  region  of  the 
splanchnics.  Also,  one  way  is  by  loosening  all  of  these  muscles,  or  yon 
might  have  the  patient  upon  the  face  and  work  as  I  have  already  shown 
you,  by  working  against  the  muscles,  and  this,  restricted  particularly  to 
the  splanchnic  region,  will  stimulate  the  splanchnics.  There  is  one  more 
important  way  in  which  we  reach  the  splanchnics,  and  it  is  something  we 
apply  usually  to  the  treatment  of  the  liver,  which  of  course  must  be  done 
directly  over  the  splanchnics.  In  treating  the  liver  I  always  end  in  this 
way.  reaching  over  with  the  left  hand  I  place  it  against  the  angles  of  the 
right  ribs,  bent  at  the  metacarpo-phalangeal  joints  to  make  a  fulcrum 
of  the  hand,  the  knuckles  resting  upon  the  table.  Then,  having  hold  of 
the  arm  of  the  patient  just  below  the  elbow,  I  push  it  up  and  back  near 
the  head,  and  then  backward :  that  raises  the  ribs,  and  it  gets  an  effect 
also  upon  the  splanchnics  directly:  it  will  also  act  mechanically  in  freeing 
the  ribs  and  giving  the  liver  more  space  in  which  to  work.  Once  more 
as  to  how  we  can  reach  the  splanchnics  in  front.  This  is  the  motion  I 
use  just  at  the  abdomen ;  deep  pressure  until  you  can  feel  the  ab- 
dominal aorta.  It  is  apt  to  hurt  some  patients  quite  a  little.  You  will 
have  to  be  very  careful,  some  it  will  not  hurt  much,  and  if  you  do  it 
gently  and  with  quite  a  prolonged  pressure,  you  can  often  get  the  most 
astonishing  results.  It  is  said  also  that  this  pressure  treatment  is  very 
good  to  condense  gas  in  the  bloating  of  the  abdomen. 

As  to'the  examination  of  the  thorax,  it  is  quite  a  long  subject,  and  I 
will  have  to  let  some  of  it  go  over  until  the  next  lecture,  but  I  might 
call  your  attention  to  the  importance  of  making  very  careful  examination 
of  the  thorax. 

In  EXAMINING  THE  THORAX  you  should  have  the  patient  lying  flat  upon 
his  back.  First,  remember  that  the  right  side  is  usually  a  little  larger 
than  the  left.  You  should  by  inspection,  next  the  skin  if  possible,  see  that 
both  sides  are  about  the  same  size — that  one  does  not  bulge  more  than  the 
other.  You  will  find  important  changes  in  the  shape  of  the  thorax.  For 
instance,  I  saw  a  case  of  enlargement  of  the  heart  from  cigarette  smoking ; 
there  was  a  perceptible  bulge  in  the  precardial  region.  In  another  case, 
one  of  asthma,  I  saw  quite  a  bulge  upon  the  right  side  in  the  region 
of  the  upper  ribs.  Also  see  that  when  the  patient  is  standing  the  thorax 
is  in  shape;  that  is,  that  one  side  is  not  dropped  more  than  the  other. 


EXAMINATION    OF   THE   THORAX.  135 

Sometimes  we  will  find  one  side  of  the  thorax  dropped.  It  is  proper  in 
making  your  examination,  especially  by  palpation,  to  put  both  hands  upon 
the  corresponding  parts,  so  that  you  involuntarily  compare  them.  If  I 
were  examining  this  thorax  upon  the  left  side  particularly,  I  would  put  my 
left  hand  upon  the  side  opposite,  so  that  I  could  compare  the  parts. 

Of  course,  examine  in  front  and  behind.  Then  pass  your  hand  over 
the  surface  of  the  skin  to  detect  any  departure  from  the  normal  tempera- 
ture. I  have  already  noted  the  importance  of  that  in  examination  of  the 
liver;  in  conditions  resulting  from  diseased  liver  it  is  said  that  very  fre- 
tiently  cold  spots  are  found  upon  the  surface  of  the  body.  However,  you 
wili  have  to  .be  a  little. careful  on  a  warm  summer  day,  a  person  being  in 
a  state  of  perspiration,  the  skin  will  cool  very  rapidly. 

You  should  observe  the  shape  of  the  thorax— whether  the  general 
shape  be  normal.  In  an  infant  you  will  find  it  cylindrical.  In  asthma  and 
emphysema  you  will  find  the  characteristic  barrel-shaped  chest.  In  what 
is  known  as  the  paralytic  chest,  the  antero-posterior  diameter  is  lessened 
and  the  chest  is  flattened.  I  have  mentioned  that  in  cases  of  neurasthenia. 
The  rachitic  chest  is  flattened  upon  the  sides.  Also  look  closely  at  the 
sternum.  It  may  be  abnormally  protruded  or  retracted,  or  there  may  be 
malposition  at  the  junction  of  the  first  and  second  parts,  and  the  ensiform 
appendix  may  be  deflected  to  one  side. 

Finally,  look  at  the  clavicle  and  the  coracoid  process.  You  know 
where  to  find  the  coracoid,  on  the  front  of  the  shoulder  at  the  origin  of  the 
coraco-brachialis  muscle.  It  is  easily  found  by  exploring  in  the  infra- 
clavicular  space  outward.  Sometimes  fibers  of  the  deltoid  get  caught  below 
it,  sometimes  fibers  of  the  brachial  plexus.  The  clavicle  may  be  up  or 
down  at  either  extremity.  You  will  acquaint  yourself  with  the  normal 
feeling  here  at.  the  junction  of  the  clavicle  with  the  scapula  and  will 
readily  detect  when  it  has  slipped  up  or  down.  You  can  also  see  if  it  has 
slipped  xdown  by  seeing  whether  it  is  close  to  the  coracoid  process  at  the 
scapular  end;  you  will  recognize  whether  it  corresponds  with  the  normal. 
At  the  upper  part  of  the  sternum,  the  clavicle  sets  up  quite  prominently. 
It  may  slip  down  or  be  too  high  up,  and  you  must  learn  to  look  for  these 
things  carefully. 


LECTURE   XX. 

At  the  last  lecture  I  considered  especially  the  splanchnic  nerves. 
showing  you  their  origin,  that  they  arise  from  as  high  as  the  third  dorsal 
down  to  the  twelfth;  that  they  were  composed,  largely  at  least,  of  white 
medullated  fibers,  that  they  were  closely  connected  with  the  cord,  since 
they  arise  from  the  spinal  nerves  themselves,  and  with  the  various  visceral 


136  LANDMARKS   OF   THE  THORAX. 

plexuses,  also,  which  rule  organic  life;  that  they  were  extremely  important 
in  the  work  of  the  Osteopath,  and  that  since  the  general  health  was  so 
often  involved  in  the  troubles  of  the  viscera,  therefore  he  worked  upon 
them  very  frequently;  the  fact  that  he  worked  usually  directly  for  the 
benefit  of  the  action  he  would  get  up  on  abdominal  life,  and  that  also  he 
frequently  worked  in  a  regulative  way,  using  the  spb.nchnics  for  vaso- 
motor  control,  thus  influencing  large  quantities  of  blood,  drawing  them 
from  parts  of  the  body  where  a  congestion  may  have  existed.  I  spoke 
in  general  also  concerning  congestion,  and  the  way  we  treat  it.  I  also 
brought  out  certain  landmarks  concerning  the  thorax  and  certain  points 
in  examination  of  the  parts  of  the  thorax.  I  wish  to  continue  that  sub- 
ject to-day. 

I.  LANDMARKS  OF  THE  THORAX :— The  interval  below  the 
clavicle  is  the  sub-clavicular  space,  between  it  and  the  upper  margin  of  the 
pectoralis  major  below,  and  the  deltoid  externally,  and  is  important  as  a 
guide  to  us  to  find  the  coracoid  process.  By  drawing  the  arm  up  and  back- 
ward, in  this  way  tensing  those  muscles,  we  can  find  the  sub-clavicular 
space,  and  at  the  outer  part  near  the  shoulder,  we  can  find  the  inner  side 
of  .the  coracoid  process.  Also  that  space  corresponds  in  direction  to  the 
direction  of  the  axillary  artery;  we  can  feel  it  pulsing  there,  and  can  com- 
press it  against  the  second  rib.  The  internal  mammary  artery  runs  perpen- 
dicularly to  the  cartilages  of  the  ribs,  and  about  half  an  inch  external  to  the 
margin  of  the  sternum.  Its  perforating  branch  at  the  second  intercostal 
space  is  the  chief  one. 

It  becomes  important  for  Osteopaths  in  examination  of  the  heart  to 
know  just  what  its  topography  upon  the  chest  wall  would  be.  The  follow- 
ing description  of  the  outline  of  the  heart  on  the  chest  wall  is  given : 

The  BASE  corresponds  to  a  horizontal  line  drawn  from  the  third 
costal  cartilages,  their  upper  border,  extended  a  half  inch  to  the  right  and 
an  inch  to  the  left  of  the  sternum;  the  APEX  is  found  by  measuring  one 
inch  internal  and  two  inches  below  the  nipple,  this  point  being  between  the 
fifth  and  sixth  ribs;  the  LOWER  MARGIN  may  be  outlined  by  drawing  a 
line  from  this  point  of  the  apex,  bulging  slightly  downward  to  the  end  of 
the  sternum,  the  xiphoid  cartilage  excepted,  that  line  extended  as  far  as 
the  right  edge  of  the  sternum;  the  RIGHT  BORDER  would  therefore  be 
indicated  by  a  line  joining  a  point  at  the  right  inferior  extremity  of  the 
sternum  with  a  point  on  a  level  with  the  cartilages  of  the  third  rib,  ex- 
tended half  an  inch  to  the  right,  while  on  the  LEFT  THE  BORDER  would  be 
indicated  by  a  line  drawn  from  the  left  extremity  of  this  line  at  the  base, 
an  inch  from  the  sternum  on  the  level  with  the  third  costal  cartilage,  down 
to  the  point  which  indicates  the  apex.  In  that  way  you  would  get  the 
outline  of  the  heart  upon  the  chest  wall.  It  is  said  that  a  needle  passed 
into  the  third,  fourth  and  fifth  intercostal  spaces  on  the  right  side  just  next 


LANDMARKS    OF    THE   THORAX.  137 

to  the  sternum,  would  perforate  the  lung,  pericardium,  and  the  right 
auricle.  A  needle  passed  into  the  second  interspace  would  perforate  the 
aorta  at  its  greatest  bulge,  also  the  part  of  the  pericardium  which  is  re- 
flected over  the  first  part  of  the  aorta.  And  that  a  needle  perforating  the 
first  intercostal  space  on  the  right  of  the  sternum  would  enter  the  superior 
vena  cava. 

This  rule  is  given  for  finding  the  extent,  or  outlining  in  general  the 
dull-sounding  space  in  the  precardial  region  made  by  the  presence  of  the 
heart;  take  a  point  midway  between  the  nipple  and  the  lower  end  of  the 
sternum,  xiphoid  excepted,  a  point  midway  for  your  center,  and  describe 
about  that  a  circle  with  a  radius  of  two  inches,  and  that  will  include  prac- 
tically all  of  this  dull-sounding  region  over  the  heart. 

The  apex  of  the  heart,  as  you  know,  beats  between  the  fifth  and  sixth 
ribs.  Its  impulse  is  readily  felt  there,  but  that  is  not  an  invariable  place 
to  find  it.  You  can  change  the  position  of  the  heart  by  changing  your 
position.  You  may  cause  the  heart  to  deviate  from  its  usual  locus  by 
turning  from  side  to  side.  In  deep  inspiration  the  heart  may  descend 
somewhat,  so  that  when  you  have  taken  a  deep  breath  you  may  feel  the 
beating  of  the  heart  over  the  pit  of  the  stomach. 

As  to  the  VALVES  OF  THE  HEART  and  their  location  externally :  The 
aortic  valves  are  located  behind  the  third  intercostal  space  close  to  the  left 
border  of  the  sternum;  the  pulmonary  valves  at  the  junction  of  the  third 
costal  cartilage  with  the  sternum,  on  the  left :  the  tricuspid  valves  are  on  a 
level  with  the  cartilage  of  the  fourth  rib  just  behind  the  middle  of  the 
sternum,  and  the  mitral  valves  are  at  the  third  intercostal  space,  about  an 
inch  to  the  left  of  the  sternum.  Since  the  valves  are  close  together  they 
are  readily  covered  by  the  tip  of  the  stethoscope  or  by  the  ear.  And  since 
they  are  covered  by  a  small  amount  of  lung  tissue  you  can  hear  the  heart 
better  by  having  the  patient  hold  the  breath  while  you  listen  to  the  beating 
of  the  heart.  For  the  reason  that  these  valves  are  so  close  together  it  is  better 
in  trying  to  distinguish  the  sounds  from  each  other,  to  go  out  a  little  way 
in  the  direction  of  the  current  from  the  valve.  Thus,  in  sounding  the  aortic 
valves,  you  would  go  to  the  second  intercostal  space,  just  at  the  right 
edge  of  the  sternum.  For  sounding  the  pulmonary  valves,  you  would  go 
to  the  second  intercostal  space  at  the  left  edge  of  the  sternum.  To  sound 
the  tricuspids  you  would  take  the  point  at  the  end  of  the  sternum  just 
behind  the  middle,  and  to  observe  the  sound  of  the  mitral  valves  you  would 
listen  at  the  apex  of  the  heart.  That  is  according  to  the  direction  that  the 
blood  currents  take. 

For  finding  the  OUTLINE  OF  THE  I.UXGS  upon  the  chest  wall:  You 
know  that  they  rise  above  the  clavicle  an  inch  and  a  half,  or  in  some  cases 
two  inches;  that  there  is  very  little  lung  tissue  behind  the  first  part  of  the 
sternum;  from  the  claviculo-sternal  articulation  down  to  about  the  second 


138  EXAMINATION   OF  THE  THORAX. 

rib,  the  anterior  edges  of  the  lungs  converge.  From  the  second  to  the  fourth 
they  are  close  together  in  the  median  line,  quite  close,  also  about  parallel. 
Below  this  point  their  course  on  the  different  sides  is  different.  On  the 
right  side  it  follows  down  along  the  course  of  the  sixth  costal  cartilage. 
On  the  left  it  is  notched  for  the  heart,  descending  back  of  the  heart.  On 
the  left  side  it  descends  as  far  as  the  lower  border  of  the  fourth  rib,  which 
it  follows.  It  reaches  a  line  drawn  perpendicularly  from  the  nipple,  at  the 
lower  edge  of  the  sixth  rib.  In  the  axillary  region  on  each  side  it  is  found 
at  the  lower  edge  of  the  eighth  rib,  and  behind,  extends  as  far  down  as  the 
tenth  rib.  Of  course  in  the  deep  inspiration  it  descends  still  lower. 

.  II.  EXAMINATION  OF  THE  THORAX.— (Continued.)— I  began 
to  take  up  this  examination  at  the  last  meeting.  I  wish  first  to  give  you 
some  points  concerning  the  divisions  of  the  thorax,  which  I  thought  best 
to  describe  to  you  for  the  sake  of  your  understanding  them  when  you  meet 
them  in  your  reading,  so  that  you  will  know  what  is  meant  by  the  mammary 
region,  the  scalpular  region,  etc.  This  division  is  the  one  adopted  by 
Loomis.  He  divides  the  chest  first  into  THREE  GENERAL  REGIONS,  the  an- 
terior, lateral  and  posterior.  The  area  on  the  ANTERIOR  aspect  is  again 
divided:  The  supra-clavicular  portion  is  that  just  above  the  clavicle.  The 
clavicular  portion  is  that  corresponding  to  the  inner  three-fifths  of  the 
clavicle,  and  is  bounded  by  that  bone.  The  infra- clavicular  space  extends 
from  the  lower  border  of  the  third  rib ;  internally  it  is  bounded  by  the 
edge  of  the  sternum,  and  externally  by  a  perpendicular  line  dropped  from 
the  junction  of  the  middle  and  outer  third  of  the  clavicle.  Next  below 
comes  the  mammary  region,  extending  from  the  lower  border  of  the  third 
rib  to  the  lower  border  of  the  sixth  rib.  extending  inward  as  far  as  the 
edge  of  the  sternum,  and  outward  as  far  as  the  last  described.  Next,  as 
for  the  sternal  region:  There  is  the  suprasternal  region,  which  he  de- 
scribes as  the  region  just  above  the  sternum.  The  superior  sternal  region 
is  that  portion  behind  as  much  of  the  sternum  as  lies  above  the  inferior 
border  of  the  third  rib  and  the  inferior  sternal  region,  that  behind  the  rest 
of  the  sternum. 

On  the  POSTERIOR  aspect  we  iiave  three  regions :  The  supra-scapular 
and  scapular,  corresponding  to  the  space  from  the  second  to  the  seventh 
ribs  inclusive,  and  corresponding  respectively  to  the  supra-spinatus  and 
infra-spinatus  fossse  of  the  scapula,  extending  inward  in  this  region  as  far 
as  the  axillary  region.  The  infra-scapular  region  extends  from  the  lower 
angle  of  the  scapula  and  the  seventh  dorsal  vertebra  do^wn  to  the  lower 
margin  of  the  twelfth  rib;  extending  internally  in  this  case  to  the  spines 
of  the  vertebrae,  and  externally  to  the  inferior  axillary  region.  There  is 
also  an  interscapular  region,  one  on  each  side,  corresponding  to  the  space 
between  the  second  and  sixth  ribs,  and  between  the  inner  or  spinal  edge 
of  the  scapula  and  the  spines  of  the  dorsal  vertebrae.  Speaking,  by  the 


EXAMINATION    OF   THE   THORAX. 


139 


way,  of  listening  to  the  sound  of  the  aorta,  it  is  also  heard  in  the  region  of 
the  back  from  the  third  down  to  the  ninth  dorsal  vertebra. 

Laterally  we  have  the  axillary  space,  bounded  above  by  the  axilla,  and 
below  by  a  line  projected  from  the  mammary  space,  that  is,  from  the 
inferior  border  of  the  third  rib.  Then  we  have  the  infra-axillary  space 
extending  from  the  axillary  space  above  down  to  the  lower  margin  of  the 
I2th  rib;  bounded  in  front  by  the  infra-mammary  region  and  posteriorly 
by  the  infra  scapular  region. 

You  know  already,  as  for  as  practical  for  our  work,  the  contents  of 
these  different  regions,  especially  when  studied  in  conjunction  with  the 
points  I  have  already  given  you  in  these  landmarks.  As  I  said,  I  give  these 
general  regions  to  you,  not  to  detail  the  parts  found  in  them,  but  so  that 
you  will  understand,  when  an  author  speaks  of  these  general  regions,  what 
he  is  speaking  of.  You  are  of  course  aware  that  in  making  a  physical 
diagnosis,  of  which  our  method  largely  consists,  we  use  auscultation,  in- 
spection, percussion,  palpation  and  mensuration.  In  our  examination  we 
want  to  hear  and  see  all  that  we  can  that  is  going  on  about  the  human 
body,  especially  in  the  way  of  examining  and  making  out  things  which 
have  caused  a  departure  from  the  normal.  I  mentioned  certain  points 
at  the  last  lecture  in  relation  to  the  chest. 

There  is  another  point  tjiat  I  wish  to  speak  of  which  is  important  in 
our  practice,  and  that  is  the  movement  of  the  chest,  as  to  whether  the  two 
sides  correspond ;  whether  one  side  is  restricted  in  movement,  as  in  the 
case  of  pneumonia,  or  whether  the  inferior  ribs  are  drawn  in,  as  in 
most  cases  of  asthma,  where  I  have  seen  them  drawn  in  extensively. 
Also  note  whether  or  not  the  action  of  the  opposite  side  is  normal  or 
increased  to  compensate  for  lack  of  normal  on  the  other  side.  It  is 
taken  as  a  very  good  sign  of  tuberculosis  if  there  is  a  depression  in  the 
infra-clavicular  region.  A  great  deal  more  might  be  said  about  these  dif- 
ferent methods  of  physical  diagnosis,  but  it  is  hardly  the  place  here  to  go 
into  them  extensively.  In  considering  palpation,  that  is  the  examination 
on  the  surface  with  the  hand,  I  brought  up  certain  points  last  time. 
We  should  not  only  touch  both  sides  of  the  thorax  in  making  the  ex- 
amination, but  we  should  touch  with  equal  force,  touch  in  the 
corresponding  place  each  time,  and  you  need  not  lay  your  hand  on 
heavily,  lightly  is  sufficient. 

Auscultation  and  percussion  are  by  for  the  most  important  methods 
in  dealing  with  the  chest,  especially  since  it  contains  the  heart  and  lungs, 
and  to  get  a  good  idea  how  the  heart  and  lungs  are  behaving  we  must 
listen  to  them  directly  and  also  listen  to  them  by  percussing  the  region  in 
which  they  lie.  The  authors  have  different  methods  of  bringing  out  these 
points.  I  have  been  reading  Lootnis  and  he  has  very  good  points.  They 
all  make  this  statement,  that  percussion  is  either  immediate  or  mediate. 


140  EXAMINATION   OF   THE   THORAX. 

Immediate  percussion,  or  direct  tapping  upon  the  part,  is  the  old  method 
and  is  very  little  used  nowadays.  The  mediate  style  is  the  one  used  most, 
in  which  you  use  a  little  rubber  tipped  hammer  as  you  percuss,  and  what 
is  known  as  a  pleximeter  placed  between  the  hammer  and  the  part  sounded. 
This  is  very  rarely  used.  It  is  stated  by  some  authors  that  we  have  as 
good  instruments  as  necessary,  the  middle  or  index  finger  of  the  left  hand 
being  the  pleximeter,  and  the  fingers  of  the  right  hand  being  the  hammer. 
There  are  certain  simple  rules  that  we  may  adopt  in  using  this  method  of 
physical  diagnosis.  First,  it  will  be  of  little  value  to  you  to  find  a  differ- 
ence in  sound  unless  both  sides  of  the  chest,  or  of  the  part  of  the  body  which 
is  being  examined,  are  similarly  disposed,  so  that  one  is  not  in  a  higher 
plane  than  the  other.  You  must  be  extremely  careful  of  the  position  of  the 
patient.  Then,  also,  you  should  have  the  parts  slightly  tensed.  For  in- 
stance, in  examining  the  chest  the  arms  should  drop  downward  and  the 
head  be  thrown  back.  If  you  are  percussing  the  axillary  region,  have  the 
arms  lifted.  If  you  are  percussing  the  back,  have  the  patient  stoop  over 
slightly  so  as  to  bring  tension  on  the  part  percussed.  That  should  be  done 
evenly ;  a  patient  should  not  have  one  arm  down  and  the  other  over  the 
head.  The  condition  on  each  side  should  be  similar.  It  is  well  to  make 
the  examination  directly  upon  the  skin,  or  if  that  is  not  practicable,  make  it 
upon  some  thin,  soft  cloth  spread  over  the  chest,  of  such  a  nature  that  it 
will  not  interfere  with  the  sound.  You  should,  of  course,  percuss  equally 
on  each  side,  and  in  case  of  the  lungs  you  should  take  it  at  the  same  stage 
of  respiration,  that  is,  you  should  not  tap  on  one  side  while  the  patient  is 
inhaling  and  on  the  other  side  while  the  patient  is  exhaling.  You  should 
have  an  equal  pressure  with  the  pleximeter  finger,  and  an  equal  forcibleness 
of  the  striking  hand,  because  you  can  make  the  sound  different  by  strik- 
ing harder  on  one  side  or  by  holding  the  hand  more  loosely  against 
the  surface  you  are  examining.  The  best  percussing  motion  comes  from 
the  wrist  and  not  from  the  whole  arm,  and  in  general  tap  lightly  for  an 
examination  of  the  superficial  parts  and  more  forcibly  for  parts  more 
deeply  located. 

In  the  practice  of  auscultation  the  same  general  rules  will  apply.  You 
have  the  immediate  in  which  you  apply  the  ear  directly  to  the  part,  or  you 
have  the  mediate  in  which  you  use  some  instrument,  as  a  stethoscope.  The 
authors  differ  a  great  deal  as  to  whether  a  stethoscope  should  be  used. 
Loomis  is  particular  that  it  should  be  used  in  examining  the  heart,  but 
does  not  care  much  for  it  in  examining  the  lungs.  Raue  says  he  prefers 
in  all  cases  the  use  of  the  ear  alone  unless  considerations  of  cleanliness 
make  it  convenient  for  the  use  of  the  stethoscope.  If  you  are  examining 
the  chest  and  it  is  covered,  see  that  the  covering  is  a  thin  soft  cloth,  a 
towel  will  usually  do;  something  that  will  not  interfere  with  the  sound. 
See  that  your  patient  is  in  a  proper  condition,  with  both  parts  disposed 


HOW    TO   EXAMINE   FOR    DISPLACED    RIBS.  141 

alike,  and  give  your  full  attention  to  the  sound  itself.  The  ear  should 
be  evenly  applied  in  each  case  alike,  not  forcibly  but  firmly.  You  should 
listen  to  the  corresponding  parts,  and  in  touching  you  should  touch 
over  the  corresponding  parts,  for  instance  it  would  not  do  to  tap  over 
a  rib  on  one  side  and  over  the  interspace  on  the  other.  You  must  ex- 
amine the  corresponding  parts,  no  matter  how  you  do  it,  and  especially 
in  respiration  it  is  better  to  examine  under  conditions  as  nearly  normal 
as  possible;  have  the  patient  breathing  quietly  and  in  a  natural  way. 

I  mention  these  things  to  you  more  for  the  sake  of  a  hint  of  what 
there  is  in  the  subject  and  what  there  is  for  you  to  study,  since  it  is 
quite  a  complex  matter  to  go  in  detail  over  the  different  sounds  that 
you  will  hear,  and  to  do  so  would  probably  confuse  you  more  than 
elucidate  the  subject.  Also  it  is  very  difficult  to  show  these  things 
without  clinic  material,  and  you  can  only  'earn  them  by  practice.  You 
should  become  perfectly  familiar  with  the  sound  of  the  normal  parts, 
both  on  auscultation  and  percussion,  and  then  you  will  note  any  de- 
parture from  the  normal  when  you  come  to  make  examinations,  and 
also  to  distinguish  the  different  abnormal  sounds  one  from  another.  I 
would  advise  you  to  become  familiar  with  the  instruments  that  you  are 
going  to  use.  Get  familiar  with  the  sounds  by  the  ear  if  you  are  going 
to  use  the  ear,  or  familiar  with  a  certain  stethoscope,  as  the  sounds  vary 
with  different  instruments. 

III.  HOW  TO  EXAMINE  FOR  DISPLACED  RIBS.  I  examined 
the  different  parts  of  the  thorax  at  the  last  time.  In  the  first  place,  I  need 
hardly  to  remind  you  that  in  variations  in  the  spine,  any  abnormal  curve 
in  the  spine,  either  CURVATURE  or  departure  from  the  normal  curves,  will 
tend  to  alter  the  normal  position  of  the  ribs.  In  examining  the  spine,  if 
you  find  that  the  parts  are  not  in  normal  position,  you  will  at  once  look  for 
dislocations  or  luxations  in  the  ribs  corresponding  with  the  affected  part 
in  the  spine.  You  may  find  a  general  alternation  in  the  shape  of  the  chest, 
as  for  instance  the  flattening  in  the  paralytic  chest  in  its  anter-posterior 
diameter;  or  flattening  in  the  lateral  diameter  in  rachitis,  or  bulging  or 
barrel-shaped  chest  in  asthma  or  emphysema.  You  will  then  see  at  once 
that  there  is  a  change  not  only  in  the  thorax  in  general  but  in  its  parts 
necessarily,  and  you  will  probably  find  that  the  ribs  are  misplaced.  To 
examine  and  replace  subluxated  or  displaced  ribs  is  one  of  the  most 
important  parts  of  our  practice,  not  only  because  it  occurs  so  frequently, 
but  because  it  is  very  troublesome.  They  often  cause  serious  trouble  and 
are  hard  to  locate  in  some  instances,  they  will  require  your  very  careful 
attention,  i 

We  might  explain  why  it  is  that  ribs  when  displaced  cause  so  much 
trouble.  I  think  the  theory  already  advanced  will  explain  that  as  far 
as  it  goes,  that  is,  parts  out  of  the  normal,  whether  they  be  ribs  or 


142  EXAMINATION   FOR   DISPLACED    RIBS. 

vertebra,  will  bring  pressure  in  some  car,es  upon  structures  such  as 
nerves  and  blood-vessels;  in  other  cases  they  would  drag  ligaments 
across  important  structures.  In  other  cases  they  n:ay  result  in  con- 
tractures  and  that  will  be  followed  by  other  results  already  noted.  So 
in  examining  a  spine  and  the  chest  particularly  you  should  examine 
each  rib.  I  have  already  given  you  the  rules  for  counting  the  ribs,  and 
having  found  where  each  rib  is  you  should  examine  each  rib  in  particular. 
It  is  said  where  a  rib  is  displaced  you  will  very  likely  find  tender  points 
along  its  course.  Dr.  McConnell  says  that  usually  there  is  a  tender 
point  at  the  spine  where  it  is  displaced,  another  about  the  middle  region, 
and  another  at  the  anterior  end.  You  will  also  find  cases  where  they 
are  sore  almost  all  the  way  along,  especially  the  anterior  half.* 

The  ribs  may  be  pressed  together  behind  and  separated  in  front.  In 
general  you  will  look  for  the  soreness  over  the  rib  and  over  the  part  of 
the  interspace  which  is  narrowed.  I  have  found  that  to  be  so  in  my 
experience.  The  displaced  rib  may  be  separated  from  one  rib,  which 
naturally  causes  it  to  be  approximated  to  some  other  rib,  and  you  will 
judge  which  it  is  by  finding  the  widening  above  and  the  narrowing 
below,  for  any  one  rib  or  any  group  of  ribs.  Then  your  rib  may  be 
changed,  not  being  slipped  up  or  down,  but  may  be  twisted  so  that  you 
will  find  the  edge  more  prominent,  and  in  this  case  it  is  very  common 
to  find  the  under  edge  the  most  prominent.  The  best  method  that  I 
have  found  in  examination  is  to  use  the  tips  of  the  fingers  and  follow 
down  the  course  of  the  intercostal  spaces.  You  can  then  learn,  know- 
ing the  normal,  whether  or  not  these  parts  are  too  much  separated  or 
too  close  together;  you  will  also  note  whether  or  not  they  are  not 
twisted. 

Sometimes  the  cartilages  will  be  distorted,  and  in  that  case  you  will 
find  an  irregularity  and  a  tenderness  along  them.  They  may  be  twisted 
or  may  have  been  torn  and  grown  together.  I  have  seen  several  cases 
in  which  the  cartilage  had  been  broken  away  from  the  tenth  rib,  and 
the  person  had  three  floaters  on  each  side  instead  of  two.  It  is  said 
to  be  a  fact  that  there  is  a  little  weaker  attachment  of  the  cartilages  to 
the  ends  of  the  ribs  in  the  case  of  the  tenth  than  in  the  case  of  the 
other  ribs.  In  examining  the  ribs  of  the  patient  what  I  have  said  will 
apply  to  all  of  the  ribs,  but  of  course  we  must  apply  our  examination 
to  all  parts  of  the  thorax,  anterior  and  posterior.  But  in  examining  the 
first  and  second  ribs  you  will  find  that  something  more  of  a  consideration. 
The  first  and  second  ribs,  on  account  of  their  attachment  to  the  scaleni 
muscles;  are  usually  displaced  upward,  because  the  tendency  of  these 
muscles  when  contracted  is  to  draw  the  ribs  upward.  In  the  first  place, 


*See  Appenix,  13. 


MANIPULATION    OF   THE    CLAVICLE.  143 

how  would  you  tell  whether  or  not  this  first  rib  is  up?  To  find  it  you 
feel  down  about  the  middle  point  of  the  clavicle,  press  down  and  back 
and  you  will  immediately  come  to  the  first  rib.  You  must  first  know 
that  the  clavicle  itself  is  in  position.  If  its  acromial  and  clavicular  ends  are 
both  in  situ,  then  you  can  judge  from  the  relative  position  of  the  first 
rib  whether  it  is  up  or  down.  Of  course  the  more  it  is  slipped  up,  the 
more  it  tends  to  come  on  the  level  with  the  upper  edge  of  the  clavicle. 
or  if  it  is  down  it  will  widen  the  space  between  them.  That  is  one  of 
the  best  ways  of  determining  by  examination  whether  it  be  up  or  down. 
The  second  rib  is  somewhat  more  difficult  to  get  at.*  You  can  feel  it. 
as  I  noted,  in  the  outer  portion  of  this  infra  clavicular  spree  by  drawing 
the  arm  outward  and  down,  tensing  the  muscle.  You  can  also  examine 
it  by  finding  the  junction  of  the  first  and  second  parts  of  the  s:ernum; 
follow  the  cartilage  out,  you  can  feel  it  as  far  as  the  clavicle.  Note 
whether  the  points  are  sore  at  the  places  where  you  can  reach  the  rib; 
and  by  following  further  there  will  be  a  difference  in  the  intercostal 
space,  and  you  can  tell  whether  the  second  rib  is  upv  or  down,  but  it  will 
require  practice  and  I  will  promise  you  that  the  first  snd  second  rib- 
are  very  hard  to  deal  with.  Just  as  the  first  two  ribs  are  usually  up,  the 
last  two  by  some  strange  compensation  of  nature,  go  down.  As  the  man 
said,  "There  is  compensation  in  everything:  sncw  comes  down  in  win- 
ter and  ice  goes  up  in  summer."  The  reason  why  these  last  two  ribs 
go  down,  especially  the  last  one,  is  that  the  quadratus  lumborum 
muscle  is  attached  to  it,  and  it  seems  to  be  the  nature  of  the  eleventh 
to  follow  the  twelfth  in  its  course  downward,  I  do  not  know  just  why. 
unless  it  is  because  it  is  not  attached  by  a  cartilage  to  the  others  above. 
and  is  free  to  follow  the  other.  The  position  of  these  ribs  is  very 
readily  ascertained  even  in  a  fleshy  person.  It  will  take  considerable 
dexterity  of  touch  to  accustom  you  to  find  them,  but  by  patience  you 
can  do  it.  Any  of  these  ribs  may  not  only  be  slipped  up  or  down,  but 
one  may  overlap  another.  I  saw  a  case  the  other  day  in  which  the 
tenth  was  overlapping  the  eleventh  quite  prominently.  Then,  you  may 
find  that  these  last  two  floating  ribs  instead  of  being  down  may  be  up. 
and  the  twelfth  may  be  pushed  up  under  the  eleventh.  In  that  case 
they  often  cause  trouble,  but  they  may  sometimes  be  down  without  any 
trouble  at  all,  in  which  case  it  will  not  be  necessary  for  you  to  bother 
with  them.  ' 

I  wish  to  tell  you  how  to  set  the  clavicle.  I  noted  it  in  the  examina- 
tion the  last  time.  Suppose,  in  the  first  place,  it  is  down.  It  may  be  down 
at  either  end.  I  believe  the  commonest  place  for  it  to  be  down  is  at  the 
outer  end,  because  of  the  attachment  of  the  deltoid  and  of  the  pcctoralis 
major  to  it  at  the  outer  end.  The  way  Doctor  Still  told  me  to 

*See  Appendix,   1. 


144  MANIPULATION    OF   THE   CLAVICLE. 

treat  that  is  to  place  the  fingers  against  the  anterior  edge  of  the 
clavicle  near  the  sternal  end,  draw  the  arm  then  inward,  across  the  chest, 
thus  relaxing  the  ligaments  and  the  muscles.  Then  push  upward  upon 
the  first  point  that  I  noted,  the  anterior  edge  of  the  clavicle,  push 
upward,  and  draw  the  arm  up  backward.  Thus  having  relaxed  the  liga- 
ments and  muscles,  your  push  will  serve,  on  account  of  the  peculiar  shape 
of  the  clavicle,  to  push  it  in  to  its  proper  articulation.  In  case  it  is 
slipped  up  at  the  acromial  articulation,  that  sometimes  happens  and  causes 
a  catching  of  the  fibers  of  the  deltoid,  or  it  impinges  on  the  fibers  of  the 
brachial  plexus;  the  best  way  is  to  raise  the  arm  to  relax  all  muscular 
tension,  since  it  is  bound  to  the  shoulder  here  by  the  deltoid  partly,  and 
some  of  these  smaller  muscles;  relax  them  in  that  way,  then  you  can 
place  your  fingers  in  behind  the  part  that  is  slipped  up,  and  it  does  not 
make  much  difference  which  way  you  throw  the  arm.  Dr.  Harry  Still 
says  when  a  joint  is  out  almost  any  way  you  turn  it,  it  will  want  to  go 
back  where  it  belongs,  which  of  course  is  true,  that  is  the  tendency  to- 
ward the  normal. 

In  case  it  is  down  at  the  sternal  end,  which  you  find  with  a  fair  degree 
of  frequency,  one  of  the  best  ways  is  to  thrust  the  thumb  of  one  hand 
under  behind  the  sternal  end  of  the  clavicle,  thrust  it  in  deeply,  and  relax 
the  muscles  by  drawing  the  arm  up  and  inward.  Then  by  drawing  the 
arm  over,  down  and  out  and  thus  tensing  the  muscles,  it  brings  a  leverage 
upon  that  end  of  the  clavicle,  and  will  force  it  up.  Or,  you  do  practically 
the  same  thing  by  bringing  the  arm  up  and  around  and  making  a  twist 
in  such  a  way  as  to  tense  the  muscles.  In  other  words,  this  is  just  a  sys- 
tem of  animal  mechanics  whereby  you  study  out  the  shape  of  the  bones, 
their  attachments  and  ligaments,  attachment  of  the  muscles,  and  just 
how  to  use  these  ligaments,  bones  and  muscles  as  levers  and  pulleys,  so 
as  to  work  them  back  into  place.  Now,  if  the  clavicle  is  up  at  the  sternal 
end,  the  point  would  be  to  relax  again  and  force  it  down  from  above  by 
working  with  the  thumb  in  behind  it.  Another  good  way  to  free  the 
space  between  the  clavicle  and  the  first  rib  is  to  thrust  the  fingers  in  be- 
hind the  clavicle  where  it  is  always  tender,  and  draw  the  arm  up  over  the 
face  and  then  on  out,  thus  getting  a  very  good  leverage. 


LECTURE   XXI. 

At  the  last  lecture  I  took  up  certain  landmarks  of  the  thorax,  show- 
ing you,  among  other  things,  what  was  the  outline  of  the  heart  upon  the 
chest  wall;  where  to  note  its  valves,  and  where  to  listen  to  the  sounds 
produced  by  their  action;  that  the  point  at  which  you  should  listen  varies 


NERVE  CONNECTIONS  OK  THE  HEART.  145 

from  the  position  of  the  valve  in  the  direction  of  the  current  of  blood. 
Also  I  noted  the  topography  of  the  lung  upon  the  chest  wall.  Then  I 
took  up  certain  points  in  the  examination  of  the  thorax,  showing  you 
how  it  was  divided  into  the  different  regions;  then  spoke  concerning 
auscultation,  palpation,  mensuration,  percussion,  etc.,  the  different 
methods  that  we  use.  Then  I  brought  up  to  the  point  of  how  to  examine 
for  displaced  ribs.  To-day  I  wish  to  take  up  more  particularly  the  con- 
tents of  the  thorax,  viz.,  the  heart  and  lungs.  They  are,  of  course,  im- 
portant to  the  Osteopath,  and  since  they  have  so  much  to  do  with  life, 
they  must  be  carefully  looked  after.  I  think  that  the  Osteopath  has  more 
success  than  other  forms  of  healing  with  troubles  in  the  heart  and  lungs. 
A  great  many  troubles  of  the  heart  are  not  organic,  and  when  not  organic 
the  opportunities  for  Osteopathic  work  are  much  better  than  when  or- 
ganic. 

I.  SOME  CENTERS  AND  NERVE  CONNECTIONS  FOR 
THE  HEART  AND  LUNGS:  There  are  certain  facts  that  we  meet  in 
our  Osteopathic  work  which  lead  us  to  reason  about  nerve  action.  In 
the  first  place,  displaced  ribs  will  very  readily  affect  the  heart.  Sympa- 
thetic troubles,  such  as  crying  and  the  like,  are  caused  by  contractures 
along  the  left  side  of  the  back  between  the  shoulders,  or  by  displacements 
in  that  region,  displacements  of  the  third,  fourth  and  fifth  ribs  particu- 
larly. From  the  fact  that  we  can  reach  the  heart  through  the  superior 
cervical  ganglion  and  in  the  upper  dorsal  region,  on  the  left  side,  and 
from  the  fact  that  there  are  certain  centers  given,  as  that  in  the  medulla, 
and  for  the  rhythm  of  the  heart  in  the  cervical  region,  at  the  third  and 
fourth,  we  naturally  wish  to  know  what  is  the  nerve  connection,  and  why 
it  is  that  working  there  we  can  get  such  an  important  effect  upon  the 
heart.  That  we  do  get  these  effects,  of  course  our  practice  shows.  It  is 
simply  a  question  of  fitting  theories  to  these  facts.  In  the  first  place,  we 
sometimes  work  along  the  splanchnics,  and  thus  get  an  effect  upon  the 
centers,  which  I  explained  at  length  in  the  lecture  the  other  day.  Then 
there  is  our  work  in  the  upper  dorsal  region.  Those  are  the  two  places, 
except  the  neck,  where  we  get  the  most  important  effects.  Now,  as  to 
this  nerve  connection  between  the  heart  and  the  spine,  Jacobson  brings 
out  the  connection  here  very  admirably,  in  relation  to  infra-mammary 
pains.  He  shows  how  the  viscera  are  connected  through  the  sympa- 
thetics,  the  great  splanchnic  particularly,  connected  with  the  spine  as  high 
as  the  fourth,  fifth  and  sixth  spinal  nerves.  We  have  learned  that  the 
great  splanchnic  may  arise  as  high  as  the  third  also.  These  spinal  nerves 
send  certain  sympathetic  branches  to  the  aorta ;  from  the  fourth,  fifth  and 
sixth  sympathetic  ganglia  branches  are  given  off  which  form  a  plexus 
about  the  aorta.  This  plexus  over  the  aorta  gives  branches  to  the  cardiac 
plexus  about  the  heart.  Further,  there  are  branches  given  off  from  the 


14:6  NERVE  CONNECTIONS  OF  THE  LUNGS. 

fourth,  fifth  and  sixth,  cutaneous  branches,  descending  over  the  ribs  and 
supplying  parts  along  the  sixth,  seventh  and  eighth  rifos.  Hence  you 
have  a  direct  connection  between  the  pain  which  you  feel  by  means  of 
these  cutaneous  nerves  of  the  sixth,  seventh  and  eighth  interspace  which 
run  in  their  distribution  beneath  the  breast,  in  the  infra-mammary  region. 
a  connection  with  the  spinal  nerves,  and  thus  with  the  fourth,  fifth  and 
sixth  spinal  nerves,  and  through  them  out  to  the  sympathetic  plexuses 
about  the  aorta  and  the  heart.  Thus,  you  have  an  indirect  connection 
between  the  cutaneous  pain  on  the  one  hand,  and  the  heart  on  the  other. 
You  may  have  pains  in  the  infra-mammary  region  caused  by  diseases  of 
the  heart.  Hilton  also  states  something  concerning"  the  sympa- 
thetic pains  which  we  may  feel  on  the  'surface  of  the  body.  Pains  from 
diseased  viscera,  the  liver  or  intestines,  for  instance,  are  often  reflected  to 
the  region  between  the  shoulders  or  at  the  inferior  angles  of  the  scapula. 
You  can  readily  see  how  this  connection  takes  place,  between  the  sym- 
pathetics  from  the  great  splanchnics  and  the  spinal  nerves,  directed  to 
the  region  of  the  scapulae  and  the  region  between  them  and  about  their 
angles.  Thus  we  see  how  we  may  have  pain  in  a  distant  part  of  the  body- 
when  a  certain  terminal  is  affectedi  I  have,  myself,  noticed  in  certain 
cases  of  trouble  .vith  the  liver,  where  the  liver  was  tender,  that  I  could, 
by  pressure,  cause  a  pain  under  the  scapula,  especially  on  the  left  side. 

Taking  into  consideration  the  connection  between  the  heart  and  this 
upper  dorsal  region,  the  fourth,  fifth  and  sixth,  you  can  see  how  the 
Osteopath,  by  working  there,  where  he  does  very  frequently  to  affect  the 
heart,  can  get  an  effect  upon  the  heart,  and  thus  upon  the  general  circu- 
lation. I  think  I  instanced  the  point  that  by  working  along  the  splanch- 
nics, and  by  working  along  the  upper  dorsal  region,  I  could  get  import- 
ant effects  in  quieting  the  heart.  I  have  sometimes  quieted  the  heart  as 
much  as  from  ten  to  twenty  beats  per  minute,  when  it  was  running  high. 
by  work  in  this  region.  Thus  you  will  see  that  work  here  upon  the  heart 
is  directly  upon  nerve  action,  but  we  must  not  omit  to  notice  the  fact 
that  by  raising  the  ribs  we  get  a  mechanical  effect,  if  those  ribs  were  so 
lowered  as  to  narrow  the  cavity  in  which  the  heart  acts.  Any  lessening 
of  that  cavity  has  a  tendency  to  interfere  with  the  heart's  beat,  so  that 
by  mechanically  enlarging  the  cavity  we  also  get  an  effect  upon  the 
heart.  It  is  probable  also  that  the  raising  of  the  ribs  frees  pressure  upon 
nerve  connections  along  the  spine. 

Further,  as  to  connections  in  the  upper  dorsal  region  between  the 
nerves  and  the  heart,  Quain  says  that  accelerator  fibres  of  the  heart, 
derived  from  the  upper  four  or  five  dorsal  nerves,  but  chiefly  from  the 
second  and  third,  are  sometimes  found.  The  spinal  fibres  end  and  sym- 
pathetic fibres  begin  in  the  middle  and  lower  cervical,  perhaps  also  in 


EXAMINATION    OF   THE   HEART.  147 

the  first  thoracic  ganglion.  That  is,  these  fibres  really  come  from  the 
sympathetics,  the  change  of  fibres  accurring  in  the  ganglia  mentioned. 

He  says  further,  that  vaso-constrictor  fibres  of  pulmonary  vessels  have- 
been  found  in  the  dog  from  the  second  to  the  seventh  spinal  nerves,  and 
they  connect  in  the  stellate  ganglion.  In  the  dog  and  the  cat  it  is  said 
that  the  lower  cervical  and  upper  thoracic  ganglia  are  connected  to  form 
what  is  called  the  stellate  ganglion.  While  it  has  not  been  demonstrated 
in  man  that  these  fibres  arise  from  the  second  to  the  seventh,  these  vaso- 
constrictors for  the  pulmonary  vessels,  it  looks  probable  that  there  arc 
some  such  fibres  existing,  since  that  is  the  identical  center  upon  which 
we  work  to  affect  the  lungs;  the  second  to  the  seventh  dorsal. 

Howell's  Text  Book  states  that  stimulation  of  the  vagus  in  the  neck 
constricts  the  pulmonary  vessels,  while  stimulation  of  the  sympathetics 
of  the  neck  will  dilate  the  pulmonary  vessels;  also  that  there  is  noted  a 
reflex  contraction  of  the  pulmonary  vessels  by  stimulation  of  some  other 
nerve,  as  for  instance,  the  sciatic,  intercostal  nerves,  abdominal  pneumo- 
gastric,  or  abdominal  sympathetics.  This  will  call  to  your  mind  what  I 
have  said  concerning  regulative  processes,  in  our  work  upon  different 
parts  of  the  body.  I  mentioned  that  particularly  in  relation  to  the 
splanchnks;  you  see  the  reflex  effect  gained  iby  stimulation  of  these  nerves 
in  different  parts  of  the  body  and  its  effect  upon  the  lungs..  You  see  how 
general  that,  work  may  become. 

It  is  an  interesting  fact  to  note  what  Robinson  says  concerning  the 
heart  and  the  aorta,  which  are  the  foundation  of  the  circulatory 
system.  He  says  that  they  have  been  noted  at  times  to  have  periods  of 
violent,  rapid  beating,  and  that  the  heart  itself  and  the  aorta  appears  to  be 
dilated  and  to  be  working  very  forcibly;  that  feeling  of  the  pulse  in  other 
parts  of  the  body  would  not  indicate  that  the  effect  was  general.  Robin- 
son says  that  this  has  been  little  made  of  in  books,  in  fact,  he  does  not 
know  that  it  is  mentioned  except  something  about  the  aorta,  and  explains 
it  by  influence  of  one  kind  or  another  which  may  affect  the  various  local 
sympathetic  centers.  And  of  the  aorta  he  says  he  has  seen  it,  in 
case  of  a  thin  woman,  beating  violently  and  simulating  in  every  respect 
an  aneurism.  He  explains  it  by  saying  that  the  centers  in  the  substance 
or  in  the  immediate  neighborhood  of  the  aorta  are  in  some  way  affected, 
though  the  effect  may,  of  course,  be  dependent  upon  general  conditions. 

II.  EXAMINATION  OF  THE  HEART.— First,  some  general 
points  as  to  the  heart.  Doctor  Still  explains  some  of  his  recent  illness 
by  a  stoppage  of  the  aorta  at  the  point  where  it  perforates  the  diaphragm. 
He  says  that  frequently  some  injury  there  may  cause  a  constriction,  if  the 
injury  be  of  such' a  kind  as  to  allow  a  relaxation  of  the  vault  of  the 
diaphragm,  causing  a  constriction  about  the  point  where  the  aorta  passes 
through,  and  thus  restricting  the  blood-flow.  Thus,  he  says,  the  heart 


148  EXAMINATION    OF    THE    HEART. 

goes  to  pounding  to  force  the  blood  through,  and  the  result  is  palpitation 
of  the  heart.  That  is  similar  to  effects  we  have  in  other  parts  of  the  body, 
where  a  thickening  of  parts  about  an  important  structure  would  lead  to 
troubles  which  were  of  peculiar  significance  to  the  Osteopath.  So  Doctor 
Still  wears  a  belt.  He  says  that  compresses  the  lower  part  of  the  thorax 
and  allows  the  diaphragm  to  bulge  upward. 

Second,  as  to  your  examination.  You  must  take  into  consideration 
that  the  heart,  being  so  closely  connected  with  sympathetic  life  in  every 
part  of  the  body,  is  affected  by  general  sympathetic  disturbances. '  You 
may  have  trouble  almost  anywhere,  in  the  neck  or  with  the  genital  or- 
gans; or  you  get  an  important  effect  upon  the  heart  and  circulation  by 
dilation  of  the  rectal  sphincters.  Such  a  slight  cause  as  a  dropping  of 
the  acromial  end  of  the  clavicle,  or  either  end  of  the  clavicle,  shutting 
down  upon  the  circulation  through  the  su/bclavian  artery  and  vein,  gen- 
erally the  vein,  has  caused  angina  pectoris.  I  knew  of  a  very  bad  case 
where  the  patient  was 'ready  to  die  of  heart  trouble  and  looked  about  as 
bad  as  a  person  could  look.  She  was  cured  by  Doctor  Still  setting  the 
clavicle.  It  was  a  typical  case,  with  the  radiating  pains  over  the  chest 
and  all  the  accompanying  symptoms.  That  lady  is  one  of  our  graduates 
now  and  enjoying  a  lucrative  practice.  Also  the  same  kind  of  a  slip  may 
cause  a  periodic  emptying  of  the  innominate  vein,  and  thus  lead  to  a  loss 
of  a  beat  of  the  heart  occasionally,  so  that  the  heart  will  be  beating  irreg- 
ularly. So  consider  that  in  looking  for  trouble  with  the  heart,  you  will 
need  to  examine  not  only  the  region  of  the  thorax,  but  everything  that 
might  affect  the  vessels  coming  from  it.  Do  not  forget  that  the  clavicle 
or  the  first  and  second  ribs  are  apt  to  cause  troubles  of  the  heart.  The 
reason  seems  to  be  that  since  they  are  usually  displaced  upward,  they 
bring  pressure  upon  some  of  the  blood  vessels,  or  interfere  at  the  spine 
with  some. of  the  important  nerves  which  I  mentioned  in  the  previous 
part  of  my  lecture. 

I  do  not  know  but  that  it  should  be  as  much  a  matter  of  pride  with 
us  to  observe  a  professional  demeanor  in  our  calling  upon  a  patient,  as  it 
is  with  our  medical  friends.  I  have  gone  with  a  student  to  see  a  patient 
where  there  was  trouble  of  the  heart— I  remember  one  case  particularly, 
a  case  of  asthma.  I  felt  the  pulse  the  first  thing,  as  I  usually  do;  the 
heart  was  beating  at  the  rate  of  120  per  minute,  but  the  student  had  not 
noticed  it,  although  having  treated  the  case  several  times.  Always  note 
the  pulse.  It  is,  of  course,  an  important  clue  to  the  state  of  the  circula- 
tion. It  will  tell  you  whether  or  not  the  heart  is  intermitting,  whether  or 
not  the  heart  is  beating  too  strongly  or  too  weakly;  whether  or  not  the 
pulse  is  normal  in  every  respect.  The  strength  of  the  beat  you  can  tell, 
then,  and  the  frequency  and  the  regularity.  So  I  first  take  the  pulse, 
which  is  usually  found  best  at  the  left  wrist  at  the  radial  artery.  Also  note 


EXAMINATION    OF   THE   HEART.  149 

the  chest,  the  shape  of  it.  In  enlargement  of  the  heart  there  may  be  a 
bulging  in  the  precardial  region.  Or  narrowing  of  the  chest  may  inter- 
fere with  the  heart.  Do  not  forget  inspection  of  the  chest  in  examination 
for  troubles  of  the  heart.  Note  also  by  inspection  and  by  palpation  whether 
the  apex  beat  is  normal,  occurring  at  the  interspace  between  the  fifth  and 
sixth  ribs.  You  can,  by  knowing  how  it  beats  normally,  tell  when  it  has 
departed  from  the  normal,  whether  it  beat  too  strongly  or  weakly.  Or  it 
may  be  displaced  to  one  side  or  the  other  by  troubles  of  the  other  viscera, 
the  lungs,  for  instance.  By  palpation,  not  only  at  the  apex  but  over  the 
region  of  the  heart,  preferably  with  the  patient  sitting  up,  you  can  note 
the  three  points  that  you  want,  that  is,  regularity,  frequency  and  strength 
of  beat.  In  examining  for  enlargement  or  encroachment  of  other  solid 
viscera  upon  the  heart,  use  percussion.  It  is  as  well  to  percuss  next  to 
the  skin,  or  through  some  soft  thin  cloth.  The  best  way  to  make  a 
pleximeter  of  your  left  hand  is  by  laying,  not  the  whole  palm  of  your 
hand,  but  just  the  middle  finger  upon  the  surface  to  be  percussed,  and 
then  striking  it  with  the  tips  of  the  fingers  of  the  right  hand  brought  in 
line,  or  by  the  index  finger.  When  you  come  to  the  heart  you 
note  its  flat  sound.  I  noted  to  you  the  other  day  how  to  find  that  region, 
a  circle  drawn  with  a  radius  of  two  inches  about  a  point  midway  between 
the  nipple  and  the  end  of  the  sternum. 

In  making  percussion  over  the  parts  of  the  lungs  which  are  most 
liable  to  be  affected  in  tuberculosis,  make  it  light,  because  there  is  some 
danger  of  starting  a  fresh  hemorrhage  if  you  use  forcible  percussion. 
Light  percussion  is  as  effective  as  is  forcible.  Of  course  this  flat  sound 
of  the  heart  may  vary,  as  for  instance  in  emphysema  it  may  become  re- 
sonant. Or  it  may  be  increased  by  some  effusion  in  the  pericardium,  or 
some  effusion  in  the  pleura  or  some  enlargement  of  the  stomach  upward, 
or  by  solidification  of  the  lung,  anything  that  will  make  a  larger  area 
of  the  flat  sound  in  the  region  of  the  heart.  By  studying  these  things 
they  will  be  an  important  aid  to  your  diagnosis.  • 

We  also  practice  auscultation  upon  the  heart,  by  placing  the  ear 
over  the  region  of  the  heart.  This  is  the  best  method  of  examining  it. 
You  will  need  to  note  the  sounds  of  the  heart  particularly,  atvl 
for  doing  that  you  would  have  to  know  the  sounds  for  the  various 
valves.  Of  course  there  are  various  murmurs,  regurgitant,  restrictive, 
etc.  There  are  murmurs  that  occur  In  several  conditions  of  the  heart. 
Sometimes  there  is  a  venous  murmur,  as  in  the  jugular  vein.  It  is  said 
that  by  holding  the  vein,  and  compressing  it  for  a  few  minutes  you  can 
stop  that  hum.  To  differentiate  between  it  and  the  heart  murmur,  par- 
ticularly that  caused  by  friction  of  the  heart  against  the  percardium  when 
it  has  been  thickened  by  some  inflammatory  process,  is  difficult.  It  is 
also  difficult  to  differentiate  from  other  murmurs  in  the  heart,  and  the 


150  EXAMINATION   OF   THE   LUNGS. 

only  way  is  to  find  that  this  sound  follows,  while  the  other  accompanies 
ihe  heart  beat. 

A  great  deal,  I  am  aware,  might  be  said  about  physical  examination 
of  the  heart,  about  the  analysis  of  these  sounds,  but  should  I  go  into  that 
subject  extensively,  it  would  make  a  set  of  lectures  as  large  as  that  I  am 
delivering  in  general.  It  is  only  by  study  along  those  lines  and  by  prac- 
tice that  you  will  learn  both  the  normal  and  abnormal.  But  I  brought 
them  up  for  your  notice,  and  leave  them  for  the  more  important  part,  th-j 
Osteopathic  practice,  which  I  shall  consider  here. 

III.  EXAMINATION  OF  THE  LUNGS :— We  adopt  the  same 
methods  for  percussing  the  different  regions  of  the  chest.  For  instance, 
if  you  were  sounding  here  over  the  clavicle,  you  get  a  dull  sound,  while 
in  the  space  "below  we  should  get  a  resonant  sound;  over  the  larnyx,  espe- 
cially with  the  mouth  open,  you  get  a  higher  sound  called  tympanitic.  You 
must  become  accustomed  to  these  normal  sounds.  Anything  which  will 
cause  a  solidification  of  the  lungs  about  the  tubes  or  thickening  of  the 
tubes  themselves,  in  fact  an  accumulation  or  any  growth  which  aids  trans- 
mission of  sounds  will  change  the  character  of  these  sounds,  making  them 
more  resonant;  while  the  effusion  of  any  liquid,  such  as  blood  in  hem- 
orrhage, or  in  the  case  of  pleurisy  the  effusion  of  lymph  or  serum,  or  the 
accumulation  of  pus,  will  also  interfere  with  the  sound  and  make  it  more 
dull.  There  is  a  tympanitic  sound  found  in  the  lung  when  there  is  a  large 
cavity  not  communicating  with  a  bronchus ;  when  the  cavity  communicates 
with  a  bronchus  we  get  what  is  called  the  "cracked-pot  sound.'\ 

Our  chief  methods  of  examining  the  lungs  are  by  percussion  and  aus- 
cultation; these  are  two  of  the  best  methods.  If  I  had  time  to  go  into  the 
subject  more  fully  I  would  spend  more  time  upon  it.  As  it  is  I  can  best 
call  your  attention  to  the  more  important  Osteopathic  points  in  relation  to 
the  lungs  by  taking  up  certain  of  the  troubles  which  affect  the  lung.  As 
for  instance  in  asthma  you  may  have  trouble  anywhere  along  the  back 
from  the  second  to  the  seventh  ribs,  especially  on  the  right  side.  It  is  said 
that  the  sixth  rib  upon  either  side  may  be  displaced  and  cause  this  trouble, 
or  if  there  is  any  pain  upon  taking  a  deep  breath  probably  the  fifth  rib  is 
interfered  with.  There  also  may  be  an  interference  with  the  phrenic  and 
pneumogastric  nerves  in  the  neck,  some  stoppage  of  the  nerve-force  in 
those  nerves  will  cause  asthma.  In  case  of  bronchitis  it  is  said  the  first, 
second  and  third  ribs  are  at  fault,  especially  the  first,  or  the  clavicle  may 
be  displaced  downward,  or  either  Of  the  nerves  I  have  mentioned  in  the 
neck  may  be  impinged  upon. 

In  congested  lungs  you  will  find  the  best  method  is  to  work 
along  the  upper  dorsal  region,  raising  all  the  ribs.  I  have  at  that 
point  very  quickly  relieved  the  congestion  in  the  lungs,  simply 
raising  all  the  upper  ribs;  working  between  the  shoulders.  Hay  fever  is 


TREATMENT  TO    &\(#K_  i:HK  lilKS.  151 

f3  f  J  '  t  r 

usually  found  in  lesions  from  the  third  cervical  down  to  the  fifth  dorsal ; 
you  may  have  trouble  either  in- the  neck  or  of  the  upper  ribs,  or  the  clavicle 
may  be  displaced,  or  those  nerves  I  have  mentioned  may  be  impinged  upon. 
In  working  upon  any  of  these  troubles  where  there  is  probability  of  com- 
plication with  general  troubles,  you  must  take  that  into  consideration.  In 
relation  to  the  lungs,  DE.  Still  has  been  speaking  recently  of  the  formation 
of  gases  upon  the  lungs,  and  says  that  in  fever  the  gases  are  formed  but 
are  not  transformed  into  perspiration;  therefore  the  natural  cooling  process 
does  not  go  on  and  you  have  fever  resulting.  In  fever  his  work  is  largely 
upon  the  lungs,  he  says,  to  stimulate  them  to  action  to  cause  the  proper 
combination  of  gases  and  the  resulting  perspiration.  In  the  same  way  he 
explained  the  cause  of  the  abnormal  amount  of  secretion  of  sweat  in  cases 
of  cholera. 

As  to  HOW  TO  RAISE  THE  RIBS  :  I  brought  out  the  points  of  examination 
for  the  ribs  the  last  time.  Dr.  Charlie  Still  has  the  patient  take  a  deep 
breath,  and  then  by  placing  the  fingers  of  one  hand  upon  the  spinal  end  of 
the  rib,  and  of  the  other  on  the  sternal  end  of  the  rib,  he  pushes  the  rib 
either  up  or  down.  This  is  one  method  which  he  uses.  Dr.  McConnell 
frequently  works  with  his  knee  in  the  back,  as  do  also  the  other  operators, 
and  in  that  case  the  idea  is  to  place  the  point  of  the  knee  at  the  angle  of 
the  rib  which  is  displaced,  and  then  you  can  have  one  hand  free  to  reach 
over  the  shoulder  of  the  patient  and  get  at  the  sternal  end  of  the  rib,  while 
with  the  other  hand  you  bring  the  arm  up,  thus  tensing  the  pectoral 
muscles  and  the  latissimus  dorsi,  which  are  attached  to  the  ribs ;  drawing 
the  arm  toward  the  head,  back  and  around  in  such  a  way  as  to  draw  the 
ribs  up.  When  you  have  gotten  them  up  to  their  highest  point,  then  relax 
the  arm  and  let  it  drop,  still  holding  the  knee  and  the  hand  against  the 
ends  of  the  rib.  Dr.  McConnell,  also  sometimes  works  with  the  knee  against 
the  back  and  by  putting  both  hands  against  the  front  part  of  the  rib,  espe- 
cially when  he  wants  to  raise  the  front  part.  It  does  not  make  very  much 
difference,  anyway  you  can  get  tension  of  the  pectoral  muscles  and  th? 
latissimus  dorsi,  getting  a  leverage  on  the  ribs,  and  having  a  fixed  point 
against  the  ribs  behind ;  no  matter  hew  you  do  that  you  will  be  able  to 
move  the  rib.  There  is  another  way  which  is  frequently  used,  and  that  is, 
the  patient  being  upon  the  table  upon  his  side,  you  can  place  the  knee  in  the 
back  in  the  same  way,  you  can  place  one  hand  upon  the  arm  of  the  patient, 
the  other  upon  the  anterior  end  of  the  rib  and  draw  the  arm  up  and  back 
in  the  same  way;  thus  you  can  raise  any  one  or  all  of  the  ribs.  Also,  as  I 
showed  you  the  other  day  in  treatment  of  the  liver,  you  can  reach  across 
and  beneath  the  patient,  getting  your  fingers  against  the  angles  of  the  ribs 
and  using  the  tension  of  the  pectoral  muscles  in  the  same  way  to  draw  the 
ribs  up.  You  will  find  all  of  those  methods  quite  simple,  and  the  reason, 
perhaps,  that  there  are  so  many  different  ways  devised  to  raise  the  ribs  is 


152  TREATMENT   TO    RAISE   THE    RIBS. 

TcO   riO   32:      -^  - 


the  fact  that  you  have  to  ^W»tk  ^A,  so  many  different  positions,  sometimes 
\)ne  wifrbe  more  convenient,  sometimes  the  other.  This  will  serve  to  raise 
the  different  ribs. 

When  you  come  to  the  first  and  second  ribs  it  is  a  different  matter. 
These  displacements  are  usually  upward  owing  to  the  scaleni  muscles 
being  attached  to  them.  Hence  to  treat  them,  we  make  use  of  these 
muscles.  When  these  ribs  are  up,  one  good  way  is  to  bring  the  head  of 
the  patient  toward  the  side  of  the  rib  affected,  then  pressing  the  fingers 
down  behind  the  middle  of  the  clavicle  you  come  to  the  first  rib.  You  can 
bring  firm  pressure  there,  and  can  bring  tension  by  pushing  the  head  in  the 
opposite  direction,  thus  stretching  the  scaleni  muscles  which  are  on  a 
strain  and  which  are  holding  the  rib  up.  Thus  we  get  those  muscles 
stretched,  and  by  moving  the  head  around  and  bringing  pressure  still  upon 
the  first  rib,  you  can  press  it  downward.  That  applies  to  both  the  first  and 
second  ribs.  Of  course,  also,  in  case  of  the  second  rib  you  can  get  the 
pressure  against  the  angle  behind  and  raise  it  by  working  in  the  back, 
drawing  up  with  the  pectoral  muscles  as  before  shown. 

Dr.  Harry  Still  frequently  works  as  follows  upon  the  upper  :ibs; 
in  this  way  you  can  get  your  hands  upon  the  first  two  ribs.  He  puts 
one  hand  beneath  the  angle  of  the  rib,  the  patient  lying  on  his  back, 
and  with  the  other  he  grasps  the  elbow  of  the  patient  and  presses  the 
arm  down  across  the  chest,  thus  springing  the  ribs  out  and  up.  and 
can  get  quite  a  leverage  in  that  way.  This  is  very  good  for  the  upper 
ribs.  In  case  of  overlapping  or  twisting  of  the  ribs  the  same  motions 
that  I  have  already  shown  you  for  raising  or  lowering  the  ribs  will 
apply.  In  case  you  wish  to  treat  the  cartilages  alone,  which  you  must 
not  omit  in  your  examination,  it  is  well  to  work  with  the  fingers  against 
the  cartilages  in  front,  drawing  the  arm  up  about  the  level  of  the 
shoulder  and  pushing  it  backward,  you  thus  raise  the  ribs  and  free  the 
cartilages,  and  you  can  work  any  twist  out  of  them  in  that  way.  or 
work  them  up  or  down  at  the  time. 

As  to  the  lower  two  ribs,  they  may  be  up  or  down,  or  slipped  or 
twisted  in  different  ways.  One  of  the  best  methods  is  to  flex  both  knees, 
then,  by  placing  your  thumb  against  the  point  of  the  rib  which  is  out, 
you  can  bring  pressure  there,  with  the  fingers  of  the  same  hand  back 
of  the  angle  of  the  rib,  then  by  drawing  the  legs  down  you 
can  stretch  the  muscles.  In  case  the  displacement  has  been 
downward  by  contraction  of  the  muscles,  you  will  hold  the  rib  up 
and  thus  stretch  the  muscles.  Or  in  case  the  rib  has  been  displaced 
upward  you  must  work  it  down  as  you  go  by  tension  of  the  muscle  in 
straightening  of  the  knees,  and  by  pressure  with  the  thumb.  Dr.  McCon-' 
nell  has  the  patient  take  a  deep  breath,  he  then,  in  case  the  rib  is  dis- 
placed downward,  exaggerates  it  by  pressing  it  still  further  downward 


TREATMENT  TO    RAISE   THE    RIBS.  153 

at  the  free  end  and  upward  at  the  spinal  end,  then,  when  the  patient 
lets  the  breath  go,  he  will  simply  work  the  part  up;  he  thus  springs 
the  part,  gets  a  fulcrum  by  having  the  lung  inflated  and  allows  the  rib 
to  take  its  natural  position.  You  cannot  always  set  a  rib  at  the  first 
treatment.  It  will  sometimes  take  considerable  attention  and  consider- 
able length  of  treatment  to  effect  your  object.  There  is  also  one  more 
method  which  I  saw  Dr.  Charlie  Still  use  the  other  day  for  raising  the 
floating  ribs,  or  any  of  the  other  ribs.  This  is  what  you  would  call,  a 
quarter  turn.  He  places  his  arm  under  the  legs  of  the  patient  and  brings 
him  around  until  he  is  a  quarter  turned  off  of  the  table,  then  he  swings 
the  patient  downward,  backward,  and  upward,  on  to  the  table  again,  mean- 
while he  has  kept  the  fingers  of  the  other  hand  against  the  angles  of  the 
ribs,  and  thus  by  pressure  of  the  hand  worked  them  back  into  place. 

Q.  Demonstrate  to  us  the  method  of  giving  immediate  relief  in 
severe  cases  of  asthma. 

A.  Any  of  the  methods  that  I  showed  you  of  raising  these  par- 
ticular ribs  on  the  right  side. 

Q.  In  the  case  of  the  eleventh  or  twelfth  ribs  being  pressed  in  to- 
ward the  liver,  would  the  motion  you  gave  us  bring  it  out?  - 

A.  Yes,  sir,  by  relaxing  the  unnatural  tension,  no  matter  which 
way  the  parts  are.  These  motions  were  given  to  either  raise  or  lower 
the  ribs.  In  the  first  place,  the  motion  of  extending  the  limbs  will,  by 
the  tension  brought  upon  the  quadratus  lumborum,  draw  the  limb  down. 
You  also  push  under  with  your  thumb,  and  place  it  against  the  point 
of  the  rib  working  it  outward  as  you  go. 

Q.  If  one  lung  is  badly  diseased  would  it  affect  the  pulae  on  that 
side? 

A.  Not  particularly  on  that  side,  it  would  probably  affect  the  pulse 
in  general,  probably  make  it  weaker. 


LECTURE  XXII. 

At  the  last  lecture  I  considered  the  heart  and  lungs,  taking  up  first 
some  nerve  centers  for  the  heart  and  lungs,  showing  that  the  theory  of 
our  work  was,  first,  that  we  work  along  the  splanchnics,  getting  a 
general  equalization  of  the  circulation,  a  general  effect  upon  the  heai  t 
and  lungs,  and  further  that  we  especially  work  in  the  upper  dot  sal  region 
for  this  effect.  I  also  showed  you  the  relation  between  intercostal  and 
infra-mammary  pains — pains  coming  from  the  6th,  7th,  and  8th  cutaneous 
nerves  referred  back  to  the  4th,  5th  and  6th  intercostal  nerves,  these 
connecting  with  the  plexus  about  the  aorta,  and  in  that  way  with 


154  THE   LYMPHATICS. 

the  heart;  also  that  in  the  same  way  a  connection  could  be  traced  from 
the  viscera  to  the  spinal  nerves,  especially  the  4th,  5th  and  6th;  and 
explained  the  visceral  pains  referred  to  the  surface  of  the  body  about 
the  shoulders  ami  between  the  scapulae.  Then  I  mentioned  certain 
accelerator  fibers  for  the  heart  and  lungs,  and  took  up  the  examination 
of  the  heart  and  lungs,  but  had  not  time  to  go  into  the  treatment  cf 
them.  I  also  showed  you  the  different  methods  of  raising  the  ribs.  To- 
day, in  the  latter  part  of  my  lecture,  I  wish  to  consider  the  general  treat- 
ment of  the  heart  and  lungs. 

Having  previously  taken  up  the  spine,  head,  its  parts,  and  the  thorax, 
we  have  now  come  to  the  abdomen,  which  I  wish  to  consider  to-day. 
First,  however,  some  general  points  concerning  the  LYMPHATICS.  Occa- 
sionally the  question  arises  in  an  Osteopath's  mind,  what  is  his  duty 
in  reference  to  the  lymphatics?  What  can  he  do  with  them?  Since 
they  are  important  in  the  nutrition  of  the  body,  how  can  he  gain  control 
of  them?  Of  course,  since  they  have  to  do  with  nutrition,  they  are 
affected  by  general  conditions  of  the  body.  Anything  which  affects  the 
general  nutrition  of  the  body  will  affect  the  lymphatics,  and  vice  versa. 
You  find  glands  along  the  lymphatics,  conglobate  glands,  as  they  are 
called,  especially  in  the  neck,  although  every  part  of  the  body  is  sup- 
plied with  them.  I  have  mentioned  the  fact  that  the  lymphatics  are 
scavengers,  and  that  if  you  note  any  enlargement  in  the  neck,  it  shows 
some  trouble  in  the  head.  I  have  one  case  particularly  in  mind,  a  case 
of  measles,  followed  by  a  serious  trouble  of  the  eyes,  where  these  glands 
were  enlarged,  and  had  been  so  for  quite  a  while.  Another  case  of 
measles  with  whooping  cough  had  been  followed  by  enlargement  of  the 
glands.  Another  case  I  noted  where  an  operation  had  been  performed 
near  the  knee  for  abscess,  it  was  on  a  cadaver  that  I  saw  it;  the  glands 
at  the  groin  were  still  enlarged,  that  being  the  set  of  glands  in  the 
course  of  the  lymphatics  which  drained  the  lymph  from  the  limb.  In 
tonsilitis,  or  septic  processes,  these  glands  are  affected.  It  is  well  that 
is  so,  for  they  prevent  the  passage  into  the  blood  of  this  septic  matter, 
which  would  result  in  blood  poisoning.  In  such  cases  I  have  called  to 
your  mind  that  you  must  not  treat  directly  over  the  gland,  but  indi- 
rectly, to  remove  the  original  cause. 

*As  to  the  direct  treatment  that  we  give  to  the  lymphatics,  you  often 
find  that  the  clavicle  is  down,  and  in  such  case  it  may  stop  up  the 
opening  of  the  thoracic  duct  into  the  subclavian  vein,  so  we  have  to 
look  to  see  whether  or  not  the  clavicle  is  lowered.  The  first  rib  may 
cause  the  .game  trouble  by  being  raised.  A  tightening  of  the  tissues  in 
these  parts  may  cause  a  stoppage  of  the  thoracic  duct  or  of  the  right 


*See  Appendix,  15. 


CONTROL   OF   THE    LYMPHATICS.  155 

lymphatic  duct.  Little  is  known  concerning  the  innervation  of  the  lym- 
phatic system.  It  is  known  that  the  lymphatic  vessels  are  supplied  in 
their  middle  and  inner  coats  with  involuntary  muscular  fibers.  The 
physiologists  tell  us  that  the  flow  is  influenced  in  three  main  ways.  First, 
the  general  muscular  exercise  of  the  body,  aided  by  the  action  of  the 
valves  in  the  lymphatics  which  prevent  a  backward  setting  of  the  lymph, 
helps  forward  the  flow.  Another  method  by  which  its  flow  is  aided  is 
the  movement  of  the  thorax  in  inspiration  and  expiration;  the  pumping 
motion  of  the  chest.  The  third  way  is  the  vis  a  tcrgo,  the  force  of  the 
circulation  behind — the  continual  expulsion  of  the  lymph  from  the  blood 
vessels  forcing  the  onward  flow  of  the  lymph  in  the  lymphatic  system. 
The  flow  is  restricted  by  the  presence  of  the  glands  in  the  course  of  the 
lymphatics. 

However,  it  is  stated  that  there  are  certain  nerves  controlling 
all  these  lymphatics.  That  there  are  fibers  in  the  upper  cervical  region 
which  control  the  caliber  of  the  duct.  That  probably  the  thoracic  duct  itself, 
and  the  general  lymphatic  system  are  under  the  control  of  the  sym- 
pathetic system.  And  the  receptaculum  chyli  is  probably  under  control 
of  the  splanchnics  directly.  There  is  a  point  at  the  fourth  dorsal  called 
by  Doctor  Still  the  center  for  nutrition.  He  works  there  in  cases  of 
obesity,  as  well  as  in  the  upper  cervical  region.  In  cases  of  obesity  also 
there  is  frequently  an  enlarged  cushion,  you  might  call  it,  of  flesh  in 
the  upper  dorsal  region;  you  will  find  it  in  almost  every  case  where 
a  person  is  extremely  fleshy.  It  is  said  that  the  enlargement  affects  not 
only  the  general  condition  of  the  body,  but  the  heart  and  the  eyes  as 
well,  and  I  have  frequently  seen  it  so.  In  the  treatment  of  obesity,  we 
treat  in  this  region  to  reduce  that  cushion  of  flesh;  work  also  at  the 
4th  dorsal  and  in  the  upper  cervical  region,  working  along  the  transverse 
processes,  alternately  stimulating  and  inhibiting  nerve  force,  and  thus 
getting  an  effect  upon  the  thoracic  duct.  So  the  Osteopath  sometimes 
works  directly  to  remove  some  obstruction,  as  for  instance,  at  the  clav- 
icle or  the  first  rib,  and  then  the  effect  that  he  may  get  through  its 
nerve  supply,  added  also  to  the  effect  that  he  gets  by  general  manipu- 
lation of  the  body,  the  stimulation  of  the  lungs,  and  the  working  of 
the  parts,  which  would  all  aid  the  onward  flow.  And  where  the  trouble 
with  the  lymphatic  system  is  due  to  the  general  condition  of  nutrition, 
there  he  would  get  his  indirect  effect  by  working  upon  the  lungs,  heart, 
bowels,  liver,  kidneys,  and  all  the  excretory  and  nutritional  organs. 

As  to  the  ABDOMEN,  we  know  that  it  is  important  to  us  from  the  fact 
that  its  contents  are  so  often  complicated  with  disease.  It  contains  im- 
portant organs  of  nutrition.  These  organs  are  directly  accessible  to 
pressure  from  the  outside,  hence  it  is  the  Osteopath  works  so  frequently 
upon  the  abdomen.  Here  I  believe,  too,  we  are  in  danger  of  becoming 


156       NERVE  CENTERS  AND  CONNECTIONS  OF  THE  ABDOMINAL  CONTENTS. 

masseurs — simply  to  knead  the  abdomen,  as  you  might  say,  which  is 
not  the  principle  at  all,  although  we  work  upon  the  abdomen  and  fre- 
quently knead  it.  The  principle  is  to  work  for  the  blood  and  nerve 
control,  as  in  other  cases;  occasionally  we  do  use  kneading  to  force 
onward  the  fecal  matter  in  the  large  intestine. 

The  abdomen  is  important,  then,  since  it  is  related  to  the  general 
health,  and  is  readily  reached  by  us.  The  fact,  also,  that  we  reach  it 
through  the  splanchnic  nerves  along  the  spine,  of  which  I  have  already 
spoken,  and  through  the  solar  plexus  in  front,  which  we  can  get  b> 
deep  pressure,  makes  it  an  important  part  to  us.  When  -we  work  upon 
these  nervous  connections  we  have  influenced  the  various  viscera,  since 
they  are  all  connected. 

II.  SOME  NERVE  CENTERS  AND  NERVE  CONNECTIONS 
OF  THE  ABDOMINAL  CONTENTS.  The  general  facts  in  this  con- 
nection have  already  been  considered.  I  have  mentioned  the  effect  of 
abdominal  tumors — the  fact  that  a  tumor  pressing  upon  the  sympathetics 
may  produce  an  effect  in  distant  parts  of  the  body.  I  call  your  atten- 
tion again  to  the  familiar  splanchnics.  You  know  where  to  reach  them; 
nervous  influence  passes  from  them  to  the  solar  plexus,  the  solar  plexus 
is  intimately  connected  with  the  other  pi^vertebral  plexuses,  viz.,  the 
hypogastric  and  the  cardiac,  and  these  in  turn  are  connected  with  the 
secondary  plexuses — the  diaphragmatic,  the  superior  and  the  inferior 
mesenteric,  the  renal,  the  coeliac,  prostatic,  vesicle  and  uterine,  and  all 
the  secondary  plexuses.  So  it  is  not  strange  that,  as  I  stated,  there  will 
hardly  an  hour  pass  in  your  practice  that  you  will  not  work  upon  th« 
splanchnics  and  the  solar  plexus,  through  which  we  reach  the  abdomiiuu 
organs.  Because,  as  you  know,  this  chain  of  sympathetic  ganglia  extends 
the  full  length  of  the  cord;  there  are  four  lumbar  and  four  sacral  ganglia, 
and  branches  from  the  lumbar  cord  pass  to  these  plexuses  of  the  sym- 
pathetic and  have  to  do  with  the  life  of  the  viscera.  Sometimes  reflected 
impulses  are  sent,  as  for  instance,  abdominal  tumor  causing  hypertrophy 
first,  and  then  degeneration  of  the  heart. 

However,  to  take  a  slightly  different  course,  I  wish  to  call  your  atten- 
tion to  the  explanation  given  for  a  frequently  observed  phenomenon,  that 
is,  in  hysteria  frequently  a  pain  is  felt  in  the  hip  or  knee,  a  cramping  of  the 
leg,  or  pain  on  the  inside  of  the  knee.  The  explanation  given  by  Hilton  is 
as  follows;  that  from  the  ovaries  and  uterus,  which  are  supplied  by 
sympathetics,  branches  run  back  to  the  sacral  sympathetic  ganglia,  thence 
branches  run  to  connect  these  organs  and  nerves  with  the  great  sci- 
atic and  with  the  obturator  nerve,  also  with  the  sacral  plexus  of  nerves. 
Now,  the  great  sriatic,  as  you  know,  supplies  the  thigh,  or  at  least  sends 
branches  to  the  hip  joint,  and  the  abturator  also  has  articular  branches  to 
the  knee  joint.  Hence,  it  is  not  strange  that  uterine  irritation  may  produce 


NERVE  CENTERS  AND  CONNECTIONS  FOR  THE  ABDOMINAL  CONTENTS.   157 

a  pain  along  the  paths' of  these  nerves,  and  may  affect  the  hip  or  knee-joint 
or  both.  The  same  thing  is  noted  in  intestinal  diseases,  where  the  irrita- 
tion in  "the  lower  bowel  may  send  the  same  kind  of  an  irritation  over  the 
same  nervous  connections  and  on  down  the  leg,  and  you  have  a  sciatica 
caused  by  trouble  in  the  bowel.  Cases  have  been  noted  frequently  in  our 
practice,  where  a  pregnant  uterus  or  the  pressure  of  a  large  amount  of 
fecal  matter  will  cause  a  cramping  of  the  leg;  a  twisted  ilium  would  have 
the  same  effect.  These  nerve  connections  are  all  extremely  interesting  to 
us.  However,  we  should  not  lose  sight  of  the  main  points  in  our  work 
upon  nerve  conditions ;  when  we  are  considering  nerve  connections  we  are 
apt  to  become  too  theoretical.  If  we  can  trace  the  pain  up  the  leg  to  the 
sacral  plexus  and  find  a  twisted  ilium,  we  have  done  the  work  which  is 
almost  peculiar  to  the  Osteopath.  So  it  is  that  we  must  look  for  the 
original  cause  whatever  it  may  be.  And  remember  that  it  is  very  fre- 
quently that  the  Osteopath  finds  a  displacement  of  parts,  and  the  successes 
of  our  practice  have  been  largely  because  we  understood  where  to  look 
for  and  how  to  adjust  misplaced  parts. 

In  the  first  few  lectures  I  gave  you  certain  centers  which  had  to  do 
with  the  viscera,  for  instance,  the  second  lumbar,  being  the  center  for  par- 
turition, defecation  and  micturition.  But  there  are  other  nerve  fibers  sup- 
plying these  parts  which  I  wish  to  call  to  your  attention.  I  noted  the  fact 
that  Dr.  Still  calls  the  nutrition  center  in  general  from  the  6th  dorsal 
down,  and  so  you  will  see  that  it  has  to  do  with  visceral  life,  and  hence 
with  the  nutrition  of  the  body  very  largely.  Quain,  in  speaking  of  the 
-lumbar  portion  of  the  sympathetics,  says  that  spinal  fibers  descend  in  the 
cord  from  the  lower  dorsal  region,  and  that  fibers  also  pass  from  the  first 
one  or  two  lumbar  nerves  to  the  plexuses  of  the  sympathetics,  and  that 
they  carry  vaso-constrictor  and  secretory  fibers  to  the  lower  limbs.  These 
have  been  demonstrated  more  particularly  in  animals,  but  there  is  not 
much  doubt  but  that  they  exist  in  man;  also  vaso-constrictor  fibers  to  the 
abdominal  vessels  are  found  in  these  nerves ;  and  motor  fibers  to  the 
circular,  and  inhibitory  fibers  to  the  longitudinal  muscles  of  the  rectum. 

From  the  lumbar  nerves  we  get,  first,  motor  fibers  to  the  bladder.  They 
pass  down  to  the  hypogastric  plexus  on  the  pelvic  plexus,  and  are  then 
distributed  to  the  bladder.  They  supply  the  circular  muscles,  including  the 
sphincter  of  the  bladder,  and  probably  also  some  inhibitory  fibers  to  the 
longitudinal  fibers  of  the  bladder.  In  the  next  place,  we  get  motor  fibers 
to  the  uterus,  which  follow  the  same  course  as  the  motor  fibers  to  the 
bladder.  It  is  a  fact  that  there  are  no  spinal  nerves  from  the  sacral  region 
running  to  the  ganglia  of  the  sympathetic.  The  spinal' fibers  which  run  to 
the  sympathetic  ganglia  in  this  region  come  from  the  lumbar  cord  or  from 
the  lumbar  nerves,  and  it  is  through  the  spinal  branches  of  the  sacral  nerves 
that  we  get  the  effect  that  we  do  by  our  Osteopathic  work  in  the  sacral 


158  NERVE   CENTERS   AND   CONNECTIONS   FOR    PELVIC   VISCERA. 

region.  Hence,  the  importance  of  all  the  work  the  Osteopath  does  upon 
this  region  for  the  pelvic  viscera.  Frequently  you  work  along  the  lumbar 
region  to  get  an  effect  upon  the  organs  contained  in  the  pelvis,  and  it  is 
on  account  of  the  sympathetic  connections  here  rather  than  with  the  sacral 
cord,  that  we  work  here.  However,  we  work  also  down  lower,  but  where 
we  work  in  the  sacral  region  we  get  an  effect  upon  spinal  nerves.  The 
fourth  sacral  nerve,  spinal,  having  branches  from  the  second  and  third, 
and  sending  branches  to  the  fifth,  is  called  by  Gaskell  one  of  the  pelvic 
splanchnics,  as  it  has  visceral  branches.  Having  connection  with  these 
upper  sacral  nerves  it  runs  out  to  form  a  plexus  with  the  sympathetic*, 
and  goes  to  the  bladder  and  other  pelvic  viscera.  We  frequently  work 
over  the  sacral  region  to  release  tension  there;  set  the  coccyx,  or  set  a 
slip  in. the  innominate,  or  remove  anything  which  may  affect  nerve  force 
From  these  visceral  branches  of  the  sacral  nerves  we  get  the  follow- 
ing: First,  motor  fibres  to  the  longitudinal,  and  inhibitory  fibres  to  the 
circular  muscles'  of  the  rectum;  second,  motor  fibres  to  the  bladder,  prob- 
ably chiefly  to  the  longitudinal  muscles.  Third,  motor  fibres  to  the 
uterus;  fourth,  secretory  fibers  to  the  prostate  gland.  So  here  we  have  a 
rather  anomalous  condition  of  working  directly  upon  the  spinal  nerves  to 
get  a  direct  effect  upon  the  viscera.  You  will  find  that  from  the  sacral 
fibres,  through  the  spinal  nerves,  we  get  certain  fibres  to  the  bladder  and 
rectum  which  are  contrary  in  their  action  to  the  fibres  to  the  bladder  and 
rectum  derived  from  the  lower  lumbar  region ;  for  instance,  the  fibres  to 
the  longitudinal  muscles  of  the  bladder  are  motor,  while  those  to  the  cir- 
cular muscles  of  the  bladder  are  inhibitory  in  the  case  of  the  sacral  nerves. 
In  case  of  the  lumbar,  they  are  just  the  oppos;te — inhibitory  to  the  longi- 
tudinal muscles  and  motor  to  the  circular  muscles  of  the  bladder.  This 
applies  also  to  those  to  the  rectum,  so  that  you  have  for  the  bladder  and 
rectum  in  one  case  motor  fibres,  and  in  the  other  case  inhibitory  fibres, 
and  thus  you  have  it  under  your  control. 

The  Osteopathic  centers  for  these  parts  I  have  already  given  you. 
You  remember  that  we  work  upon  the  fourth  sacral  for  the  sphincter  ani, 
upon  the  fourth  to  relax  the  vagina,  and  upon  the  second  and  third  for  the 
sphincter  of  the  bladder.  In  passing,  I  might  also  call  your  attention  to 
the  importance  of  the  fifth  lumbar  as  a  center.  It  is  important,  in  the 
first  place,  because  we  so  very  frequently  get  a  displacement  there,  it 
being  the  point  of  weakness,  the  junction  of  the  spinal  column  with  the 
pelvis;  and  important,  in  the  next  place,  because  it  is  a  center  through 
which  we  work  to  reach  the  hypogastric  plexus. 

There  are  certain  points  about  the  abdomen  which  may  be  more  or  less  fa- 
miliar to  you,  which  I  wish  to  bring  up  for  the  sake  of  refreshing  your 
memory  before  we  proceed  further.  These  are  according  to  Holden  as  be- 
fore. The  linea  alba,  as  you  know,  extends  from  the  apex  of  the  ensiform 


LANDMARKS   FOR   THE    ABDOMEN    AND    PELVIS.  159 

cartilage  to  the  symphysis  of  the  pubes.  and  is  the  thinnest  part  of  the  ab- 
dominal wall.  The  lineac  semilnnarcs  extend  from  a  point  at  the  level  of 
the  anterior  ends  of  the  seventh  ribs  down  to  the  spines  of  the  pubes,  bulg- 
ing outward;  the  parts  between  them  are  attached  to  the  linea  alba  and  to 
the  semilunares,  and  are  sometimes  filled  with  extravasation  of  pus  or  fluid. 
The  lineae  transversae  are  usually  all  above  the  umbilicus,  the  lower  one  Le- 
ing  about  on  a  level  with  the  umbilicus.  These  lines  on  statuary  are  almost 
always  exaggerated,  making  the  abdomen  of  a  muscular  man  look  like  a 
chess  board,  which  is  not  correct.  These  are  interesting  to  us  further 
from  the  fact  that  any  one  of  these  squares  marked  off  by  the  transversae 
and  linea  alba  may  contract,  or  any  one  of  them  may  become  filled  with 
pus,  and  simulate  some  deep-seated  abdominal  tumor  or  other  disease. 

MARKS  ABOUT  THE  PELVIS:— In  the  erect  position  a  line  drawn 
between  the  highest  points  of  the  crests  of  the  ilia  is  just  about  on  a  level 
with  the  promontory  of  the  sacrum.  The  umbilicus  is  sometimes  stated 
to  be  the  center  of  the  body.  But  it  is  a  little  nearer  the  pubes  than  the 
ensiform  cartilage.  It  is  not  true  that  if  a  man  should  lie  down  on  his 
back  with  his  arm  outstretched,  a  circle  drawn  with  the  umbilicus  as  its 
center,  would  just' include  the  extremities,  because  this  center  varies  with 
age.  It  will  be  just  above  the  umbilicus  at  birth;  at  two  years  of  age  it 
is  just  at  the  umbilicus;  at  thirty  it  is  just  below  the  pubes  in  man, 
and  just  above  in  woman.  Of  course  it  depends  also  on  the  length  of  the 
legs.  • 

The  bifurcation  of  the  aorta  is  just  about  the  level  of  the  promontory 
of  the  sacrum,  or  you  might  say,  level  with  the  highest  point  of  the  crests 
of  the  ilia.  The  level  of  the  umbilicus,  referred  to  the  spine,  is  about  that 
of  the  third  lumbar  vertebra.  It  is  said  that,  taking  a  point  one  inch  below 
the  umbilicus  and  slightly  to  the  left,  compression  may  be  made  upon  the 
aorta.  This  point  is  taken  because  above  the  umbilicus  there  are  structures 
which  might  be  injured  by  deep  pressure.  By  feeling  here  you  can  note 
the  pulsation  of  the  aorta.  Cases  are  on  record  where  the  aorta  has  been 
compressed  here,  under  chloroform,  for  a  time  sufficient  to  cure  aneurism 
of  the  abdominal  aorta.  The  umbilicus,  as  you  know,  is  sometimes  per- 
vious, being  the  remains  of  the  foetal  artery  it  sometimes  does  not  close. 
It  is  deeper  and  wider  in  women  than  in  men.  As  it  is  some- 
times pervious,  there  may  be  a  hernia  here,  or  escape  of  pus,  or  of 
ovarian  fluid,  or  of  entozoa.  The  umbilicus  is  also  a  good  -fixed  point  from 
which  measures  are  taken  in  case  of  diseases  where  it  is  necessary  to  com- 
pare parts  of  the  body.  Measurements  are  taken  to  the  ensiform  cartilage, 
to  the  anterior  superior  spines  of  the  ilia,  or  to  the  symphysis.  It  is  fre- 
quently useful  in  fracture  to  measure  to  the  anterior  superior  spines  to  see 
how  much  the  parts  are  displaced. 


160  LANDMARKS.      TREATMENT   OF   THE   MAMMAE. 

In  the  median  line  behind  the  linea  alba  we  have  first,  the  liver  just 
below  the  ensiform  cartilage,  and  extending  about  the  breadth  of  three 
fingers.  Second,  the  stomach,  which,  when  distended,  presses  the  trans- 
verse colon  down  and  occupies  the  space  between  the  umbilicus  and  the 
liver.  When  empty  it  recedes,  leaving  a  slight  hollow  on  the  surface,  "the 
pit  of  the  stomach."  The  transverse  colon;  when  not  displaced,  the  middle 
of  it  is  just  above  the  umbilicus.  You  will  frequently  want  to  know  where 
to  find  the  transverse  colon,  and  you  can  work  on  it  here  with  a  sufficient 
degree  of  certainty.  However,  you  must  bear  in  mind  that  it  is  sometimes 
slipped  out  of  position,  as  in  enteroptosis.  Cases  are  on  record  where  it 
was  found  as  low  down  as  the  floor  of  the  pelvis.  Behind  and  below  the 
umbilicus  are  the  small  intestines,  when  they  are  not  displaced  by  a  dis- 
tended bladder.  The  peritoneum  is  loosely  attached  to  the  abdominal  wall ; 
when  the  bladder  is  not  distended  this  peritoneum  is  in  contact  with  the 
linea  alba  all  the  way  down  to  the  pubes.  But  when  the  bladder  is  much 
distended  it  rises  sometimes  half  way  to  the  umbilicus,  then  the  perit- 
oneum is  pushed  back  t>y  the  bladder,  and  between  the  peritoneum  and 
the  abdominal  wall  there  is  a  space  of  as  much  as  two  inches.  A  case  is 
on  record  where  in  the  seventeenth  century  a  blacksmith  cut  open  the 
bladder  there  and  removed  a  large  stone.  Of  course,  cutting  the  perit- 
oneum would  have  been  a  serious  matter. 

W-hen  you  wish  to  find  the  division  of  the  aorta  it  is  a  safe  way  to 
find  a  point  a  little  to  the  left  of  the  center  of  a  line  drawn  between-  the 
highest  points  of  the  crests  of  the  ilia.  And,  as  I  said,  compression  can  be 
made  at  this  point.  A  line  bulging  slightly  outward  from  this  point  to 
where  you  feel  the  pulsation  of  the  femoral  artery  will  mark  the  course  of 
the  common  and  external  iliac  arteries.  The  first  two  inches  of  the  line 
belongs  to  the  common  iliac  artery.  Of  course  these  things  vary,  the  aorta 
may  be  longer  or  shorter,  the  bifurcation  coming  above  or  below,  or  the 
common  iliac  may  be  longer  or  shorter.  There  is  one  point  in  the  exam- 
ination of  the  thorax  which  I  failed  to  mention,  and  that  is  what  is  called 
succussion.  When  there  are  fluids  in  the  body  cavities,  especially  in  the 
pleura,  a  quick  shake  and  then  the  application  of  the  ear  to  the  chest  wall 
will  give  you  a  splashing  sound  called  succussion. 

TREATMENT  OF  MAMMAE:— You  will  find  in  your  practice 
that  the  mammae  are  swollen,  inflamed  and  perhaps  caked,  and  especially 
at  the  menstrual  period.  In  such  cases  it  is  a  very  good  plan  to  free  the 
circulation  by  spreading  the  upper  ribs  both  in  front  and  behind.  Raise 
them  well  and  raise  the  clavicle,  for  there  may  be  obstruction  to  the 
internal  mammary  artery,  especially  at  the  second  interspace,  where  the 
artery  perforates  and  runs  to  the  breast.  You  will  have  good  success  in 
treating  such  cases. 


TREATMENT  OF  THE  HEART  AND  LUNGS.  161 

GENERAL  TREATMENT  FOR  THE  HEART  AND  LUNGS:— 
As  I  have  said,  this  is  just  the  indication  of  the  general  treatment.  Dr. 
Harry  Still  said  in  an  article  in  the  last  Journal  that  you  cannot  give  a 
recipe  for  each  particular  treatment,  and  it  is  foolish  to  try  to  do  so.  If 
you  write  a  recipe  and  try  to  follow  those  directions  for  any  one  case 
you  are  liable  to  get  into  trouble,  because  cases  vary.  As  he  says,  there 
are  just  as  many  nervous  systems  as  there  are  human  faces,  and  just  as 
many  kinds  of  paralysis  as  there  are  nervous  systems.  Thus  it  is  that  I 
can  give  you  only  the  general  treatment  for  these  conditions.  In  treat- 
ment of  the  lungs,  your  idea  is  to  work  upon  the  upper  dorsal  region; 
you  know  the  center  is  from  the  second  to  the  seventh.  However,  I 
might  say  concerning  the  heart  and  lungs,  that  they  are  very  closely  re- 
lated When  you  have  trouble  with  one  you  frequently  have  trouble 
with  the  other,  an«i  they  are  so  closely  related  to  the  general  health,  that 
if  you  find  trouble  in  one  place  you  had  better  look  also  in  the  other.  In 
treatment  of  the  lungs,  one  of  the  chief  things  to  do  is  to  raise  the  upper 
ribs ;  put  your  fingers  on  the  angles  of  the  upper  ribs  and  work,  pushing 
the  shoulder  down  and  back.  Or  you  can  set  your  patient  upon  a  chair 
and  place  your  knee  in  the  back,  or  your  thumb,  in  the  same  way.  I 
have  relieved  congestion  of  the  lungs  very  readily  in  that  way. 

Also,  in  treating  the  lungs  it  is  a  good  idea  to  place  the  thumb  be- 
tween the  clavicle  and  the  first  rib,  push  the  arm  across  the  chest  and 
back  over  the  face.  That,  of  course,  separates  the  clavicle  and  the  first 
rib.  I  have  noticed  Dr.  Harry  Still  use  that  method  frequently,  and  the 
idea  there  is  to  spread  these  parts,  give  the  blood  vessels  free  play — the 
subclavian,  and1  also  we  get  an  effect  upon  the  phrenic  and  the  pneumo- 
gastric  nerves  which  pass  behind  the  first  rib  in  front  of  the  scalenus  antictis 
muscle.  It  is  also  important  in  working  upon  the  lungs  to  pay  attention 
to  the  condition  of  the  pneumogastric  and  of  the  sympathetics.  Hence 
it  is  that  we  work  in  the  superior  cervical  region,  and  also  upon  the  mid- 
dle and  inferior  cervical  ganglia  of  the  sympathetic.  I  have  already 
shown  you  how  to  treat  them.  Now,  the  irritation  to  the  vagus  may  of 
course  be  sufficient  to  produce  results  in  the  lungs.  It  has  to  do  with 
the  caliber  of  the  bronchial  tubes;  it  gives  them  motor,  dilator  and  con- 
strictor fibers,  so  that  if  it  is  irritated  it  may  cause  contraction  and  cause 
a  case  of  asthma,  or  something  of  that  kind.  The  irritation  may  be  in 
the  stomach  or  in  the  throat,  or  anywhere  where  it  may  irritate  the 
pneumogastric  nerve.  If  the  superior  laryngeal  branch  is  irritated 
may  result  in  catarrhal  pneumonia.  So  you  must  look  carefully  to  tl 
nerves  and  treat  them  in  the  neck  at  the  points  I  have  indicated, 
third,  fourth  and  fifth  cervical  are  particularly  noted  because  any  dis- 
placement here  is  liable  to  affect  the  sympathetics,  which  has  to  do  with 
the  involuntary  movement  of  the  lungs.  Then  the  first  and  second  ribs 


162  TREATMENT  OF  THE  HEAKT  AND  LUNGS. 

and  the  fifth  rib  are  particularly  noted,  but  all  the  ribs  from  the  second 
to  the  seventh  are  included,  and  all  the  upper  part  of  the  spine. 

.  I  might  tell  you  also  how  to  treat  the  HEART;  it  is  largely  a  repetition 
of  what  has  been  said  for  the  lungs,  because  the  phrenic  and  pneumo- 
gastric  also  supply  the  heart,  and  you  must  always  look  to  them.  We 
frequently  work  upon  the  pneumogastric  nerve  in  the  neck,  holding 
against  it,  thus  inhibiting  its  action,  to  increase  the  beat  of  the  heart, 
because  we  thus  cause  the  inhibitory  fibers  of  the  pneumogastric  to  cease 
functioning.  That  is  simply  an  adjuvant;  as  I  have  said  before,  we  can 
get  a  better  effect  in  quieting  the  heart,  or  stimulating  it,  by  working  in 
the  region  of  the  splanchnics  and  along  the  upper  dorsal  region,  espe- 
cially on  the  left  side.  The  motions  I  have  already  given  you — any  of 
these  spreading  motions  to  spread  and  raise  the  ribs,  will  relieve  the 
heart  trouble.  As  I  have  said,  I  am  giving  you  only  the  general  treat- 
ment. In  any  particular  case  you  will  probably  find  some  one  thing  the 
matter,  you  might  find  the  clavicle  down  anti  affecting  the  heart,  you 
might  find  the  first  and  second  ribs  up  and  affecting  the  heart,  and  you 
might  find  any  particular  rib  in  the  upper  dorsal  region  displaced,  affect- 
ing the  heart. 

Q.  Suppose  you  were  treating  a  case,  and  the  patient  should  faint 
on  your  hands,  by  what  me*ans  would  you  bring  him  to? 

A.     A  good  way  is  to  first  get  the  head  of  the  patient  as  low  as  you 

-  can;  just  let  it  hang  over  the  lower  end  of  the  table;  and  to  refer  to  Dr. 

Harry  Still  again,  he  says  to  slap  them,  pull  their  hair  or  anything  to  get 

the  blood  started  to  the  head;  a  dash  of  cold  water  in  the  face  may  be  a 

good  thing. 

Q.  In  case  of  too  much  blood  to  the  head,  how  would  you  go  about 
treating  it  to  throw  the  blood  away  from  it? 

A.     I  would  work  first  along  the  splanchnics. 

Q.     Stimulating? 

A.  I  would  loosen  all  the  muscles,  first,  in  the  back,  and  then  I 
would  have  the  patient,  turn  over,  and  I  would  inhibit  or  press  deeply 
over  the  solar  plexus,  to  get  the  blood  from  the  head.  You  will  have  to 
find  out  the  cause;  the  cause  may  be  an  impacted  colon  preventing  the 
circulation  in  the  lower  part  of  the  body.  Or  you  may  stimulate  the 
lungs  and  get  it  started  through  the  whole  body;  your  idea  is  to  equalize 
the  blood  flow. 

Q.  In  case  of  too  much  heart  action,  what  would  be  the  quickest 
wav  to  reduce  it? 

A.  The  quickest  way  that  I  have  found  is  simply  to  separate  the 
upper  ribs  and  raise  them  on  the  left  side,  and  I  have  done  it  by  the  count, 
I  have  lowered  it  as  much  as  twenty  beats,  and  it  stayed  that  way  until  the 
next  treatment;  when  the  patient  came  back  two  or  three  days  later  the 


NERVE  CONNECTIONS  AND  CENTERS  OP  THE  STOMACH  AND  INTESTINES.      163 

beat  was  the  same.     Of  course  that  is  an  exceptional  case;  you  cannot 
always  reduce  it  that  much. 

Q.     Please  give  the  treatment  to  increase  the  heart  beat? 

A.  You  should  inhibit  the  pneumogastric,  thus  letting  the  heart  run 
faster;  and  then  you  would  take  the  same  movement,  because  the  object 
when  it  is  too  slow  is  a  stimulation,  and  by  raising  these  upper  ribs, 
whether  it  is  too  slow,  you  may  increase  it,  or  if  too  fast  you  can  lower  it. 
I  have  gotten  effects  either  way. 

Q.  Do  lymphatics  remain  enlarged  after  the  septic  condition  has 
passed  away? 

A.  That  is  a  very  hard  question  to  answer.  I  have  seen  them  stay 
enlarged  so  very  long  that  it  looked  as  if  they  might.  They  may  stay 
enlarged  a  long  time,  but  it  is  possible  there  is  trouble  there  yet,  espe- 
cially if  the  person  is  in  poor  health.  They  may  hypertrophy. 

Q.     Why  are  they  enlarged  in  one  place  and  not  in  another? 

A.  Because  certain  parts  of  the  lymphatic  system  drain  certain  parts 
of  the  body. 

Q.  The  treatment  you  have  given  would  be  good  also  for  irregular 
heart  action,  would  it  not? 

A.  There  are  many  things  that  would  cause  irregularity  of  the 
heart.  As  I  have  said,  a  stoppage  of  the  subclavian  vein,  causing  a 
periodical  emptying  of  it,  caused  by  a  slipping  of  the  clavicle,  would 
cause  the  heart  to  lose  a  beat.  An  irritation  to  the  sympathetics  in  the 
dorsal  region  would  cause  a  constriction  of  these  vessels  and  thus  an 
irregular  filling  of  the  heart,  causing  it  to  lose  a  beat. 

(Dr.  Harry  Still)  I  will  tell  you,  doctor,  when  it  originates  from  the 
stomach,  you  can  press  upon  the  pneumogastric  and  quiet  it.  Simple 
pressure,  from  two  and  a  half  to  five  pounds  pressure,  for  a  minute  and  a 
half  to  two  minutes. 


LECTURE  XXIII. 

To-day  I  wish  to  consider  further  the  abdomen  and  its  contents.  I 
have  already  given  you  certain  centers  for  the  vaso-motor  control  of  these 
parts,  necessarily  so  in  considering  the  splanchnics.  But  there  is  much 
more  that  might  be  said,  so  I  will  mention  some  further  fibers  which  go 
to  these  parts,  which  teach  us  how  we  can  control  them. 

First,  as  to  the  STOMACH.  We  know  that  we  reach  it  through  the  solar 
plexus  and  through  the  splanchnics,  also  through  the  vagi.  We  must 
not  forget  in  dealing  with  the  stomach  that  probably  Auerbach's  and 
Meissner's  plexuses  have  to  do  with  it  as  well  as  with  the  intestines. 
Robinson  says  that  the  gastric  and  intestinal  secretions  are  under  the 


164     CENTERS  AND  NERVE  CONNECTIONS  OF  ABDOMINAL  ORGANS. 

control  of  Meissner  and  Billroth's  plexus,  aided  by  Auerbach's  plexus. 
Further,  note  certain  statements  in  Howell's  Text  Book.  The  mesen- 
teric  vessels  are  under  the  control  of  the  splanchnics,  which  contain  both 
vaso-dilators  and  vaso-constrictors.  The  vaso-constrictors*  for  the  je- 
junum are  as  high  as  the  fifth,  and  extend  from  there  down,  it  does  not 
state  how  far.  Those  for  the  ileum  a  little  lower,  and  those  for  the  rec- 
tum come  off  still  lower  along  the  splanchnic  region.  There  are  none, 
however,  below  the  second  lumbar.  The  vaso-dilators  are  present  in  the 
same  nerves  in  these  regions,  and  here  is  a  chance  to  bring  in  a  point 
of  whether  we  inhibit  or  stimulate.  I  think  we  understand  fully  that 
point,  and  do  not  think  that  we  will  split  hairs  over  those  things.  How- 
ever, the  vaso-dilators  are  more  abundant  in  the  lower  three  dorsal  and 
in  the  upper  two  lumbar.  The  vaso-dilator  and  vaso-constrictor  fibres 
of  the  splanchnics,  ending  in  the  solar  and  renal  plexuses,  have  the  vaso- 
motor  supply  of  the  liver.  The  splanchnics  contain  the  vaso-dilators 
and  vaso-constrictors  for  the  liver  probably.  It  is  said  that  there  are 
vaso-dilators  also  in  the  vagi  nerves.  However,  this  matter  is  not  set- 
tled, and  they  are  not  perfectly  sure  about  the  existence  of  these  fibres. 
But  it  makes  little  difference  to  the  Osteopath,  since  he  can  rule  the  flow 
of  blood  through  the  liver  in  other  ways,  as  we  shall  see  presently. 

As  to  the  KIDNEYS,  there  are  vaso-motor  fibres  from  the  sixth 
dorsal  down  to  the  second  lumbar.  You  know  that  we  can  get,  more 
easily  perhaps  on  the  kidneys  than  on  any  other  organ,  a  vaso-motor 
effect  reflexly  by  the  application  of  cold  to  the  skin.  Also,  by  stimulat- 
ing the  sciatic  nerves  it  has  been  found  that  one  can  get  a  vaso-motor 
effect  upon  the  kidneys.  This  seems  to  be  in  line  with  what  has  been 
said  concerning  an  equilibrium  between  the  blood  flow  in  different  parts 
of  the  body.  There  are  certain  centers  that  the  Osteopath  works  upon. 
Doctor  Still  says  there  is  a  center  in  the  skin,  that  is,  a  peritoneal  cen- 
ter about  one  inch  each  side  of  the  umbilicus,  and  that  work  there  is 
beneficial  both  upon  the  kidneys  and  upon  the  intestines,  and  we  often 
make  a  mere  spreading  motion  there  at  the  umbilicus,  just  press  in 
deep  and  spread>,  not  hard,  for  effect  on  the  renal  veins  and  arteries. 
That  always  seems  to  have  a  good  effect  in  treating  the  kidneys.  Of 
course  you  know  the  micturition  center  is  the  second  lumbar  but  you 
have  already  been  cautioned  not  to  go  too  much  according  to  centers; 
look  for  the  lesion,  which  may  be  some  place  away  from  the  center. 

As  to  the  SPLEEN,  it  is  found  that  stimulation  of  the  peripheral  end  of 
the  splanchnics  will  cause  quite  a  change  in  the  size  of  the  spleen, 
that  is,  in  its  bulk,  but  it  is  not  really  known  whether  it  is  on  account 
of  vaso-motor  control  or  because  of  an  effect  upon  those  involuntary 
muscle  fibres  which  you  saw  under  the  microscope — you  know  how  the 
capsule  and  the  trabecuke  of  the  spleen  are  well  supplied  with  involun- 


CENTERS  AND  NERVE  CONNECTIONS  OF  ABDOMINAL  ORGANS.      165 

tary  muscle  fibres,  and  you  remember  how  the  oval  nuclei  of  those  fibres 
are  easily  seen.  However,  from  the  Osteopath's  point  of  view,  it  makes 
little  difference  whether  he  can  in  one  way  or  the  other  change  the  size 
of  the  spleen,  so  long  as  he  does  it.  that  is  what  he  is  after.  He  does 
not  care  whether  it  is  through  muscular  or  vaso-motor  control.  Should 
he  do  that,  of  course  he  would  thus  change  the  flow  of  blood  through  it. 
There  is  a  great  deal  not  understood  about  the  spleen.  There  is  a  very 
good  Osteopathic  point,  however,  in  the  treatment  of  the  spleen  in 
connection  with  treatment  for  gall  stones.  You  can  treat  for 
gall  stones  and  remove  them,  but  they  will  form  again  unless  you  treat 
the  spleen  on  the  left  side  over  the  ninth,  tenth  and  eleventh  ribs.  That 
is  part  of  the  practice.  I  have  not  heard  that  statement  refuted. 
Another  point  as  to  the  spleen — in  treating  it  you  will  sometimes 
find  it  congested;  it  is  like  the  liver  in  that  respect,  they  are  both  liable 
to  congestive  disturbances.  You  may,  by  working  deep  in  the  left  hy- 
pochondriac region,  reach  the  spleen,  but  when  the  spleen  is  distended 
with  blood  it  is  said  it  is  very  readily  ruptured;  and  if  you  find  the  spleen 
enlarged  and  tender  I  would  advise  you  to  treat  rather  over  the  back 
through  the  spinal  nerve  supply  than  over  the  abdomen.  I  think  I  might 
emphasize  once  more  the  importance  of  the  Osteopathic  work  upon  the 
abdomen.  As  I  have  already  said,  I  think  here  we  are  in  more  danger 
than  anywhere  else  -of  becoming  masseurs.  Indeed,  I  do  not  think  we 
need  to  learn  the  baker's  trade  before  we  can  work  on  the  abdomen, 
and  we  ought  to  bear  in  mind  that  although  we  knead  there,  we  work 
there  as  directly  as  in  other  parts  of  the  body  for  nerve  control  and  for 
the  blood  flow.  And  the  fact  that  we  knead  the  abdomen  occasionally 
is  not  any  sign  that  we  simply  knead  it,  as  a  masseur  does.  Of  course, 
there  are  times  when  we  depend  upon  the  mere  mechanical  movement, 
as  when  we  begin  at  the  sigmoid  and  work  on  back  to  loosen  the  fecal 
contents,  but  our  chief  work  is  upon  the  nerve  supply.  I  think  I  have 
already  mentioned  the  point  that  by  work  upon  the  abdominal  peripheral 
terminals  we  can  stimulate  or  inhibit.  I  merely  call  it  to  your  mind 
again,  that  by  getting  the  peripheral  terminals  in  the  organs  of  the  ab- 
domen, which  we  can  reach  by  pressure  over  the  abdomen,  and  by  get- 
ting these  various  plexuses  from  the  solar  down,  we  can  get  an  effect 
upon  these  organs,  and  that  is  what  we  are  reaching  when  we  are  work- 
ing upon  the  abdomen.  'For  instance,  we  frequently  work  along  the  whole 
length  of  the  large  intestine.  What  are  we  doing?  You  will  remember 
that  Auerbach's  and  Meissner's  plexuses  are  found,  the  first  between 
the  muscular  coats,  and  has  to  do  with  the  motions  of  the  intestines; 
and  second  deeper,  in  the  submucous  coat,  and  has  to  do  with  the  secre- 
tions. Now,  we  may  work  in  the  region  of  the  abdomen,  and  the  be- 
ginning Osteopath,  who  does  not  understand,  may  think  he  is  simply 


166  CENTERS   AND   NERVE   CONNECTIONS   OF   ABDOMINAL   ORGANS. 

kneading,  but  such  is  not  the  fact,  we  are  reaching  terminations  of  nerves. 
You  know  what  the  plexuses  look  like,  with  their  meshes,  in  the  inter- 
nodes  of  which  are  ganglia;  they  (the  ganglia)  are  centers  upon  which 
you  may  work  directly  by  pressure  over  the  abdomen.  Thus  it 
is  that  we  get  the  best  explanation  in  regard  to  the  Osteopath's 
success  in  treating  abdominal  troubles,  such  as  constipation,  diarrhea, 
enteritis,  and  a  whole  list  of  troubles  which  affect  man,  and  our  success 
there  is  marked.  Byron  Robinson  says:  "Gastro-intestinal  secretion 
appears  to  be  carried  on  automatically  by  the  Meissner-Billroth,  aided 
by  Auerbach's  plexus  of  nerves,  which  are  sympathetic  ganglia,  auto- 
matic visceral  ganglia."  As  I  have  said,  since  they  are  ganglia,  they  are 
centers,  and  since  they  are  automatic,  they  are  to  a  certain  extent  inde- 
pendent, and  by  stimulating  them,  whether  we  go  back  to  the  splanchnics 
so  much  or  not,  we  get  the  effect,  as  you  have  an  independent  source 
of  nerve  supply  here.  Indeed,  Robinson  in  .making  this  statement,  is 
doing  so  to  establish  his  point  that  the  sympathetic  is  largely  independent 
in  its  action.  We  must,  however,  couple  our  work  here  with  work  in 
other  places,  and  we  must  not  forget  also  that  the  nerve  centers  chiefly 
are  along  the  spine. 

We  do  our  work  largely  here  also  by  the  blood-flow.  I  have  em- 
phasized the  nerve  control  and  the  blood-flow.  Robinson  says  that  the 
movement  of  the  intestines  is  largely  dependent  on  the  amount  of 
blood  in  the  intestinal  wall.  That  is,  on  the  amount  of  fresh  blood  which 
affects  the  parenchymal  ganglia.  We  have  a  certain  number  of  ganglia 
in  these  walls,  they  must  ibe  supplied  with  blood  if  they  are  to  act  prop- 
erly; that  is  with  pure,  fresh  blood.  And  by  working  over  the  splanch- 
nics, and  by  this  manipulation  process  you  can  throw  great  quantities  of 
blood  to  the  abdominal  viscera,  and  thus  supply  these  ganglia  with  an 
added  amount  of  blood.  That  will  also  help  to  explain  how  we  get  our 
effect  upon  the  nervous  system  there.  When  you  have  done 
that  you  rule  both  secretion  and  motion.  Of  course  that  has  to  do  very 
closely  with  constipation,  diarrhea  and  those  things.  Your  peristalsis 
may  be  too  rapid,  and  thus  you  would  have  a  case  of  diarrhoea,  or  it  may 
be  just  as  rapid,  but  as  Rdbinson  says,  futile,  and  you  will  have  con- 
stipation. You  have  to  couple  with  that  work  the  ruling  of  secretions 
through  Meissner's  and  Auerbach's  plexuses,  and  if  they  are  too  abund- 
ant you  have  diarrhea;  if  deficient  you  would  have  constipation.  The 
fact  there,  as  in  other  cases,  is  that  we  remove  lesions  and  these 
secretions  attend  to  themselves,  they  become  normal;  a  change  in  the 
amount  of  motion,  and  a  change  in  the  quantity  or  quality  of  secretions; 
so  we  work  toward  the  normal. 

We   might   repeat   this    for   every    organ    in    the    abdominal    cavity. 
When    we    work    for     the    uterus,    the   bladder,    or    the   intestines,     or 


LANDMARKS    FOR    ABDOMEN.  167 

ovaries,  we  work  very  largely  through  the  nerve  control,  as  is  evidenced 
by  the  fact  that  in  case  of  those  organs  we  work  generally  through  the 
spine,  along  the  lower  part.     It  might  be  thought  that  the  motions  we 
employ  in  our  work  upon  the  liver  are  exceptions  to  this   rule,  'but  I 
think  not.     We  frequently  work  against  the  lower  edge  of  the  liver,  but 
we  cannot  work  much  of  its  bulk  by  our  direct  kneading  motion  there, 
and    I    think    what    we    do    is    the    same    as    elsewhere,    we    affect    the 
nerves  as  well.     We  affect  the  hepatic  plexus  of  the  sympathetic  directly 
by     manipulation,      and     indirectly     through      the      solar     plexus,      also 
through  the  splanchnics,  and  the  vagi.     If  you  will   watch   Dr.    Harry 
Still,   you   will   see  that  he   scarcely  ever  omits   to   treat   the   vagi   when 
treating  the  liver,  as  it  contains  vaso-motor  fibres  for  this  organ.     So  our 
work  in  kneading  is  largely  work  upon  nerve  connections.     There  is  a 
good  point  that  I  would  like  to  note  in  speaking  of  the  liver.     I  have 
seen  a  case  in   which  there  was  hemorrhage     from     the     lower  bowel ; 
whenever  the  trouble  occurred     there     would     be     a     tenderness     about 
the     liver,   and     the     portal     circulation     would  be  stopped.     There     is 
a  close  connection  between  the  portal  circulation  and  the  hemorrhoidal. 
Here  you  have  this  great  amount  of  blood  which  must  pass  to  the  ab- 
domen and  through  these  terminal  vessels,  and  which  must  find  its  way 
back  through     the     portal     circulation     and     the     liver,   to     be  worked 
upon  by  it.     These  hemorrhoidal  veins   connect  with   the   portal   veins, 
so  that  if  you  have  an  obstruction  in  the  liver  you  are  very  apt  to  find 
trouble  in  the  way  of  hemorrhoids,  or     something     of     that  kind.     Re- 
member that  there  is  a  further  object  in  freeing  the  splanchnics,  as  a 
regulative  process.     You  might  say  that  this  is  true,  but  you  might  go 
farther  and  say  that  the  liver  in  this  case  is  a  "stop  cock,"  that  it  is 
sometimes  turned  when  it  should  not  be,  is  stopping  the  blood,  and  you 
have  a  congestion  at  the  lower  bowel.     You  remember  that  the  liver  is 
particularly  liable  to  congestion.     If  it  is  congested  the  blood  flow  is  re- 
tarded and  you  have  a  series  of  abdominal  troubles. 

II.  LANDMARKS  FOR  THE  ABDOMEN.— 1  began  this  last 
time,  and  wish  to  continue  to-day.  In  examining  a  patient,  as  you 
all  know,  perhaps,  it  is  best  for  abdominal  examination  and  treat- 
ment to  have  the  patient  flat  on  the  back;  have  the  thighs  flexed  a  littie 
to  relax  the  abdominal  muscles;  have  the  head  and  neck  slightly  ele- 
vated, this  will  help  to  relax  the  recti  muscles.  Thus  you  have  every- 
thing relaxed,  and  unless  the  abdominal  wall  is  unusually  tense  through 
its  own  condition,  you  have  a  good  place  to  work.  Then  in  working,  I 
believe  that  beginning  Osteopaths  "dig"  here  perhaps  as  much  as  in 
any  other  place.  That  is,  they  use  the  ends  of  their  fingers.  Not  only 
Osteopaths  but  surgeons  make  the  statement  that  that  is  very  wrong. 
Holden  says  to  use  the  tips  of  the  fingers  causes  the  parts  to  contract. 


168  LANDMARKS  FOR  ABDOMEN. 

Thus  you  defeat  your  own  object.  You  should  lay  the  flat  of  the  hand 
on  the  abdomen.  I  have  seen  the  worst  digging  over  the  abdomen,  and 
it  is  wrong,  because  you  are  not  kneading,  and  you  cannot  force  any 
condition  there,  and  you  had  better  not  try.  Dr.  Hildreth  always  empha- 
sizes the  point  that  in  working  upon  the  abdomen  you  must  work  for 
nerve  influence;  and  that  is  especially  noted  in  typhoid  fever,  where  you 
have  an  ulceration  in  Peyer's  patches,  and  rf  you  try  to  work  matters 
along  mechanically,  you  are  liable  to  perforate  the  ulcerated  places. 

The  central  tendon  of  the  diaphraghm  is  about  on  a  level  with  the 
lower  end  of  the  sternum,  about  the  level  of  the  junction  of  the  seventh 
costal  cartilage  with  the  sternum.  The  right  half  of  the  diaphragm  will 
rise  as  high  as  the  fifth  rib  when  the  diaphragm  is  extended,  and  to  on« 
inch  below  the  level  of  the  nipple ;  rather  higher  than  one  expects 
to  look  for  it.  The  position  of  the  abdominal  contents  is  variable.  There 
is  quite  a  contrast,  says  Loomis,  between  the  examination  of  the  contents 
of  the  thorax  and  those  of  the  abdomen.  In  the  first  instance 
you  have  tense  walls  and  contents  which  may  vary  but  little  under 
physiological  conditions.  While  in  the  other  you  have  loose  walls,  you 
have  numerous  organs,  some  of  which  vary  considerably  within 
physiological  limits.  So  you  see  it  is  a  different  matter  when  you  go 
to  the  abdomen  to  examine  or  treat  it,  and  you  must  constantly  guard 
against  wrong  diagnosis  by  being  mistaken  which  organ  is  at  fault. 
Then,  too,  the  action  of  the  abdominal  organs  is  more  or  less  peculiar. 
Take  the  stomach  at  different  times,  it  changes  its  position  when  it  is 
distended;  so  it  is  with  the  bowels,  and  according  to  the  position  they 
assume,  the  others  are  also  displaced ;  you  must  bear  that  in  mind. 

I  wish  to  call  to  your  attention  the  regions  of  the  abdomen.  You 
know  that  it  is  divided  into  three  zones — the  epigastric,  umbilical  and 
hypogastric.  The  epigastric  region  is  bounded  above  by  the  diaphragm, 
below  by  a  plane  passing  from  the  anterior  tips  of  the  tenth  rib,  and 
between  the  bodies  of  the  first  and  second  lumbar  vertebrae  behind.  That 
zone  is  divided  into  a  right  and  left  hypochondriac  region,  behind  the 
false  ribs,  and  the  epigastric  region  between.  The  umbilical  zone  is 
bounded  above  by  the  epigastric  and  below  by  a  plane  passed  from  the 
highest  points  of  the  crests  of  the  ilia,  striking  a  point  between  the  first 
and  second  sacral  spines  behind.  The  lower,  or  hypogastric  zone, 
is  the  one  below  the  umbilical,  and  occupies  the  region  of  the  pelvis. 
These  two  zones  are  each  divided  into  three  regions  by  an  almost 
vertical  plane  on  each  side,  passed  frcm  the  tip  of  the  tenth  rib  to  the 
pubic  spine.  In  the  middle  zone  the  regions  are  the  right  and 
left  lumbar  and'  the  umbilical,  and  in  the  hypogastric  zone  the  regions  are 
the  right  and  left  iliac  and  the  pubic.  The  lower  zone  is  bounded  below 
by  the  upper  edge  of  the  pubes,  and  by  the  two  Pouparts  ligaments, 


LANDMARKS    FOR    THE    ABDOMEN.  169 

one  on  each  side.     It  will  not  be  necessary  to  detail  the  contents  of  these 
regions,  I  will  refer  to  the  contents  as  it  becomes  necessary  later. 

As  to  the  liver,  it  is  found  mainly  in  the  right  hypochrondriac  region. 
and  extends  across  into  the  central  or  epigastric  region,  as  far  toward 
the  left  as  the  mammary  line.  It  may  extend  down  two  or  three 
inches,  and  at  this  point,  behind  the  linea  alba  in  the  media  line  is 
the  best  place  to  find  the  liver;  it  protrudes  half  way  to  the  umbilicus. 
but  you  will  not  be  able  to  find  it  until  your  hand  is  educated.  The 
liver  may  protrude  lower  in  disease.  I  have  seen  a  liver  that 
weighed  sixty  pounds^  they  become  enormously  large  at  times.  It  may 
extend  down,  as  for  instance  in  tight  lacing,  when  it  is  not  diseased, 
and  you  will  have  to  judge  what  the  general  condition  is.  On  the  right 
side,  where  it  goes  a  little  higher,  it  may  ascend  as  high  as  the  diaphragm, 
about  an  inch  below  the  nipple,  and  below  or  as  low  as  the  tenth  dorsal 
spine.  The  liver  is  a  very  important  organ.  I  do  not  think  that  with 
all  that  Dr.  Harry  Still  says  about  the  liver  it  is  any  too  much  impressed 
upon  our  minds,  because  it  is  extremely  important  to  us  in  our  practice. 
The  gall  bladder  will  be  found  just  beneath  the  tip  of  the  ninth  rib  on 
the  right  side,  but  it  is  behind  the  liver,  and  you  are  not  able  to  find  it. 
It  is  only  when  distended  to  a  great  degree  that  it  can  be  noticed ;  even 
then  you  do  not  feel  it  directly.  But  we  work  there  \o  get  an  effect 
upon  the  gall-bladder  and  press  its  contents  out.  We  work  down  that 
duct  in  a  reversed  "S"  shape  to  the  umbilicus,  a  little  to  the  right. 

The  STOMACH  is  one  of  the  most  variable  organs  of  the  abdomen. 
You  all  know  how  much  it  descends  at  times  when  distended  with  gas  or 
over  distended  with  food.  At  that  time  instead  of  simply  descending,  it 
turns  on  its  axis,  and  the  greater  curvature  comes  to  the  f .  out,  because  the 
greater  curvature  is  not  so  closely  attached  as  the  lesser.  When  the 
stomach  becomes  thus  distended  it  will  push  away  those  organs  in  front, 
and  may  even  occupy  all  the  space  from  the  lower  edge  of  the  liver,  or  the 
tip  of  ensiform,  down  to  the  umbilicus.  In  such  a  case  you  are  likely 
to  have  great  dyspnoea  and  palpitation  of  the  heart.  I  remember  a  case  in 
which  about  three  hours  after  a  meal,  the  gentleman  had  eaten  rather 
heartily,  he  had  great  distress  in  breathing,  his  heart  was  palpitating,  and 
he  thought  he  would  die.  He  called  an  Osteopath  for  heart  trouble, 
but  the  Osteopath  worked  the  undigested  food  on  through  the  pylorus,  and 
the  gas  off  the  stomach,  and  the  man's  heart  was  all  right.  You  will  fre- 
quently meet  that  sort  of  a  case,  and  if  you  know  the  probabilities  you  can 
be  on  your  guard  against  it.  The  cardiac  orifice  is  just  below  the  cartilage 
of  the  seventh  rib  where  it  joins  the  sternum,  and  a  little  to  the  left.  The 
stomach  when  empty  retreats  behind  the  liver  and  lies  flat;  there  is  no 
cavity  whatever  in  it.  This  reminds  me  of  a  statement  made  by  Dr.  Eck- 
ley,  that  naturally  these  are  but  potential  cavities.  The  oesophagus  when 


170  LANDMARKS   FOR  THE   ABDOMEN. 

not  occupied  by  the  passage  of  food  or  drink  lies  with  its  inner  surfaces 
in  contact,  it  collapses  and  occupies  as  little  room  as  possible.  The  same  is 
true  of  the  stomach.  The  pylaric  orifice  of  the  stomach  is  found  on  the 
right,  at  the  edge  of  the  sternum  about  the  point  where  the  cartilage  of  the 
eighth  rib  joins;  it  is  behind  the  liver  and  cannot  be  felt  unless  it  is  en- 
larged by  disease. 

The  SPLEEN*  is  on  the  left  side,  below  the  ninth,  tenth  and  eleventh 
ribs ;  sounded  by  percussion  over  the  tenth  and  eleventh  ribs.  I  have 
already  given  you  some  precautions  concerning  it.  It  may  become  very 
much  enlarged,  then  you  can  readily  feel  its  edge,  but  unless  it  is  en- 
larged you  do  not  feel  it.  However,  you  can  get  indirect  pressure  on  it 
under  the  edges  of  the  left  lower  ribs.  It  is  forced  down  sometimes  in 
full  inspiration. 

The  PANCREAS  is  not  very  easily  felt;  it  lies  behind  the  stomach,  trans- 
versely, and  crosses  the  aorta  and  the  spleen  at  the  level  of  about  the 
second  lumbar  vertebra.  I  mention  it  not  because  you  will  find  it  often; 
you  can  feel  it  only  when  the  abdomen  is  very  thin  and  the  stomach 
entirely  empty;  in  some  cases  of  thin  individuals  you  might  mistake  it 
for  some  disease  of  the  transverse  colon. 

The  KIDNEYS  also  are  not  readily  felt.  It  is  said  by  Holden  that  he 
does  not  know  that  he  has  ever  felt  the  rounded  edge  of  the  kidney,  but 
he  says  it  is  accessible  to  pressure  at  the  outer  edge  of  the  erector  spinse 
muscle  between  the  lower  ribs  and  the  crest  of  the  ilium.  It  is  accessible 
to  pressure  because  you  can  get  indirect  pressure  and  can  know  when  it 
is  tender.  It  is  sometimes  enlarged  and  can  then  be  felt.  It 
corresponds  in  position  to  the  lower  two  dorasl  and  upper  two  lumbar 
vertebrae.  A  point  to  know  in  relation  to  it  is  that  it  will  sometimes 
deceive  you,  or  you  will  feel  masses  of  hardened  fecal  matter  and  think 
they  are  the  kidney,  or  vice  versa;  you  must  distinguish  between  them. 

As  to  the  LARGE  INTESTINE,  you  are  familiar  with  it.  The  caecum  and 
ilio-caecal  valve  both  lie  in  the  right  iliac  fossa.  In  the  right  lumbar 
region  and  over  the  right  kidney  runs  the  ascending  colon,  and  across 
just  above  the  umbilicus  you  find  the  transverse  colon;  the  descending 
colon  and  sigmoid  flexure  are  in  the  corresponding  positions  on  the  left 
side.  You  can  reach  all  of  the  colon  except  the  splenic  and  hepatic 
flexures.  However,  these  are  sometimes  prolapsed,  sometimes  sunken, 
as  Robinson  states.  Dr.  Tull,  of  our  own  practice,  has  pointed  out  that 
this  is  frequently  the  case,  and  that  prolapsus  may  cause  constipation 
by  acting  as  a  mechanical  hindrance  to  the  passage  of  fecal  matter  along 
the  bowel.  You  all  know  the  relations  of  the  bowel,  and  except  at  those 
two  points  you  will  be  able  to  work  upon  the  intestine  directly. 

As  for  the  SMALL  INTESTINE,  the  jejunum  lies  in  the  region  behind  the 
umbilicus,  and  is  the  part  concerned  in  umbilical  hernia.  It  is  be- 


EXAMINATION    AND   TREATMENT    OF   THE    ABDOMEN.  171 

cause  it  seems  to  be  so  particularly  vital  that  umbilical  hernia  is  so  often 
fatal.  The  point  concerning  the  ileum  is  that  it  contains  Peyer's  patches, 
which  are  inflamed  and  ulcerated  in  typhoid  fever;  they  are  in  the  lower 
part  near  the  ilio-caecal  valve,  and  just  at  the  edge  of  the  right  iliac  fossa. 
You  will  have  to  be  extremely  careful  in  treating  inflammatory  condi- 
tions of  the  bowels,  especially  typhoid  fever  and  enteritis. 

The  BLADDER  is  contained  within  the  pelvis  except  when  distended.  It 
may  become  over-distended  and  rise  out  of  the  pelvis  as  high  as  half  way 
to  the  umbilicus.  As  I  noted  at  the  last  meeting,  when  it  rises  it  pushes 
the  peritoneum  back  away  from  the  wall  of  the  abdomen,  and  sometimes 
will  leave  a  space  as  great  as  two  inches  between  them. 

I  thought  I  had  better  finish  the  subject  in  this  way  to-day,  leaving 
the  practical  examination  and  treatment  of  each  one  of  these  important 
organs  of  the  abdomen  until  next  time.  I  shall  try  to  finish  this  subject 
then. 


LECTURE  XXIV. 

At  the  last  lecture  I  considered  the  abdomen,  taking  first  certain 
centers  and  nerve  connections  for  the  contents  of  the  abdomen — the 
stomach,  intestines,  liver,  kidney,  spleen,  and  so  on,  calling  to  your  atten- 
tion the  fact  that  although  we  often  work  mechanically  upon  the  abdo- 
men, our  chief  treatment  there  is  nevertheless  for  the  reaching  of  blood 
and  nerve  supply,  taking  especially  the  case  of  the  liver  and  of  the  bow- 
els in  constipation.  I  then  took  up  certain  landmarks  for  the  abdomen. 
I  wish  to  carry  the  subject  further. 

*I.  EXAMINATION  AND  TREATMENT  OF  THE  ABDO- 
MEN AND  ITS  CONTENTS:— In  this  1  do  not  include  the  pelvis 
and  its  contents,  as  I  shall  give  a  further  lecture,  taking  up  that  subject. 
Any  one  of  these  various  organs  may  become  complicated  in  disease,  and 
the  manner  in  which  it  is  reached  and  treated  in  the  various  diseases 
might  well  take  up  a  lecture,  but  I  think  it  best  to  run  over  the  abdomen 
and  its  contents,  giving  the  Osteopathic  treatment  for  each  different  organ 
to-day,  perhaps  with  the  exception  of  the  kidney,  which  I  will  take  up 
at  the  next  time. 

First,  as  to  the  examination  of  the  EXTERNAL  PARTS  OF  THE  ABDOMEX. 
I  called  your  attention  at  the  last  time  to  the  need  of  having  the  patient 
raise  his  knees,  thus  flexing  the  thighs  slightly,  also  the  fact  that  our 
tables  raise  the  head  and  chest  a  little,  thus  relaxing  the  recti  muscles  of 
the  abdomen,  leaving  the  abdominal  walls  relaxed, '  so  that  you  can 


*See  appendix  16. 


172  EXAMINATION    AND   TREATMENT    OF   THE    ABDOMEN. 

readily  examine  them  by  touch.  You  should  also  take  care  to  see  that 
the  patient  is  evenly  disposed  on  each  side,  so  that  there  may  be  equal 
tension  of  the  abdominal  walls.  You  see  at  once  that  it  is  neces- 
sary, to  have  the  parts  equally  disposed.  We  use  the  ordinary 
methods  of  examination  of  the  abdomen — inspection,  palpation,  men- 
suration, auscultation,  and  percussion.  We  use  palpation  and  percussion 
probably  most  frequently.  The  Osteopath  depends  upon  touch  largely, 
and  also  upon  getting  the  sound  by  percussion  from  the  different  viscera, 
so  ithese  two  are  the  most  important  methods  of  examination  that  we 
have.  We  should  first  INSPECT  the  abdomen,  this  is  best  done  next  the 
skin.  We  note  its  general  appearance;  you  will  find  in  some  cases 
enlargement  due  to  inflation  from  gases  in  the  bowels.  In  such  cases  it 
is  very  likely  to  be  even.  However,  some  of  the  hollow  viscera,  as  for 
instance,  the  stomach,  may  be  inflated  with  gas,  in  which  case  you 
would  have  an  uneven  enlargement.  Further,  on  inspection  you  will 
find  whether  or  not  any  organ  is  enlarged.  Sometimes  the  spleen  en- 
larges enormously  and  pushes  farther  and  farther  down  through  the 
abdomen,  making  a  bulging  enlargement  in  its  locality.  Sometimes, 
as  I  have  said,  the  stomach  is  distended  with  food  and  gases,  and  quite 
enormously  so  Sometimes  diseases  of  the  liver  cause  it  to  enlarge,  as 
for  instance  in  sclerosis  of  the  liver.  The  liver  protrudes  below  the  ribs 
from  enlargement,  and  makes  a  protrusion  of  the  abdominal  walls,  as 
does  also  enlargement  of  the  ovaries,  and  so  on.  So  you  should  note 
whether  or  not  the  enlargement  is  equally  disposed,  as  in  gases  in  the 
intestines,  or  is  at  a  fixed  point,  in  which  case  you  will  learn  by  other 
methods  how  to  tell  what  organ  is  affected. 

We  should  also  note  the  temperature,  whether  or  not  parts  are  cold 
or  hot.  It  is  said  that  in  liver  troubles  there  are  often  cold  spots  upon 
the  surface  of  the  body,  and  we  know  that  in  cases  of  obstruction  to  the 
nerve  supply  at  the  spine  we  can  trace  the  cold  streak  across  the  body. 

Inspection  will  reveal  to  you  the  color,  which  is  significant.  In  some 
cases  the  linea  alba  becomes  pale,  or  there  may  be  splotches  of  yellow 
color,  as  in  some  diseases  of  the  liver,  jaundice,  and  in  other  cases.  In 
pregnancy  the  abdomen  assumes  different  colors,  brown,  yellowish  or 
black;  it  differs  according  to  the  person.  You  can  make  out  the  outline 
of  any  organ  and  locate  it  by  the  other  methods  of  examination. 

The  abdomen  may  be  distended  or  it  may  be  retracted,  as  in  tubecular 
diseases  of  children,  where  it  is  said  the  abdomen  is  retracted.  And  you 
will  frequently  find  in  your  practice  that  in  thin,  emaciated  people,  or  in 
any  disease  that  is  wasting,  it  is  liable  to  be  contracted.  You  will  also 
find  that  in  some  cases  it  is  distended.  In  diseases  which  affect  the  thorax, 
causing  pain  upon  respiration,  there  is  likely  to  be  a  change  in  the  ab- 
domen— anything  like  inflammation  of  the  pleura  or  pneumonia,  there  is 


EXAMINATION    AND   TREATMENT    OF    THE    ABDOMEN.  173 

restriction  of  motion  and  pain  on 'the  side  affected,  while  the  respiratory 
motions  of  the  abdomen  are  increased.  On  the  other  hand,  in  the 
abdomen  when  you  have  trouble  which  would  cause  pain  upon  motion, 
as  for  instance,  in  peritonitis,  you  have  the  restriction  of  motion  there, 
and  increased  motion  in  'the  thorax.  You  can  also  by  this  examination 
occasionally  note  changes,  even  through  the  wall  of  the  abdomen,  as  in 
cases  where  the  heart  has  been  displaced  by  some  disease  in  the  thorax. 
In  cases  of  aneurism  of  the  abdominal  aorta  you  can  see  the  pulsation 
of  the  abdominal  wall.  You  can  feel  it  very  frequently.  The  caput 
medusae,  or  little  web  of  veins  about  the  umbilicus,  may  become  en- 
larged and  engorged  with  blood,  indicating  that  somewhere  the  blood 
is  interfered  with;  it  is  usually  in  the  liver,  as  in  case  of  scirrhosis  of  the 
liver,  but  it  may  be  in  some  portion  of  the  ascending  vena  cava. 

PALPATION,  as  I  have  said,  is  important  to  the  Osteopath.  You  can 
feel  the  different  solid  viscera  in  the  different  parts  of  the  abdomen.  As 
I  have  already  mentioned,  you  can  feel  whether  or  not  there  be  tumors 
of  any  kind  in  the  abdominal  wall;  you  can  by  touch  differentiate  be- 
tween those  in  the  wall  and  those  in  the  organs;  you  can  tell  whether  or 
not  they  are  superficial  or  deep,  fluctuating  or  solid.  A  solid  tumor 
will  give  a  sound  such  as  you  get  over  the  liver — a  flat  sound;  a  liquid 
tumor  will  give  also  a  flat  sound,  but  will  give  in  addition  a  fluctuation, 
which  can  be  detected  by  palpation.  When  the  abdomen  has  its  walls 
retracted  it  is  likely  to  be  tense,  when  extended  they  are  also  likely  to 
be  tense.  In  other  cases  you  may  find  them  very  flabby,  very  loose, 
without  tone.  In  one  case  there  may  be  too  much  life,  in  the  other  case 
a  lack  of  life  or  nerve  force.  You  can  detect  that  by  the  feeling.  You 
can  also  detect  displacement  of  the  parts;  you  must  examine  to  see  if 
the  parts  are  in  their  normal  position.  The  liver  may  descend  consid- 
erably ;  the  stomach  may  be  displaced  until  it  is  resting  upon  the 
floor  of  the  pelvis.  The  spleen  may  be  enlarged  and  come  far  down. 
Any  of  the  organs  may  indicate  pathological  changes,  or  be  displaced 
or  enlarged.  The  transverse  colon  you  ,know  where  to  find,  just 
across  at  the  level  of  the  umbilicus.  It  sometimes  becomes  loaded  with 
fecal  matter  and  descends,  dragging  with  it  the  splenic  and  hepatic  flex- 
ures. In  such  case  you  will  be  able  to  make  out  those  flexures.  You  will 
also  be  able  to  make  out  fecal  tumors — accumulation  of  fecal  matter  in 
the  large  intestine.  If  there  be  pain  in  the  stomach,  and  it  increases 
upon  pressure  over  the  pit  of  the  stomach,  it  is  said  to  be  inflammatory, 
as  in  catarrh  of  the  stomach;  if  it  ceases,  it  is  said  to  be  nervous.* 

As  I  have  said,  the  method  of  PERCUSSION  is  an  important  one  in  ex- 
amination of  the  abdomen.  In  general,  percussion  over  parts  which  are 


See  Appendix  17. 


174  EXAMINATION    AND   TREATMENT   OF   THE    ABDOMEN. 

distended  with  gas  gives  a  tympanitic  sound  of  the  abdomen,  because 
there  the  gas  is  restricted  within  limits.  Over  a  stomach  or  bowel  dis- 
tended you  get  a  tympanitic  sound.  Over  the  parts  contained  in  the 
abdomen  you  get  a  varying  character  of  flat  sounds.  For  instance,  over 
the  liver  (you  know  it  is  best  reached  right  in  the  median  line,  below 
the  ensiform  cartilage)  we  get  a  flat  sound.  Over  the  lung  you  get 
a  higher,  more  resonant  sound.  You  can  compare  sounds  in  that 
way.  Over  the  region  of  the  spleen  we  get  the  same  flat  sound ; 
over  the  region  of  the  stomach  likewise.  Over  the  intestine,  the  same, 
except  the  note  is  of  a  little  higher  quality.  Remember  that  in  using 
your  left  hand  as  a  pleximeter  it  is  best  not  to  place  the  whole  hand  on 
the  abdomen,  place  the  middle  ringer  on  the  abdomen,  and  then  bring 
the  fingers  of  the  right  hand  into  line,  or  take  the  middle  finger  of  the 
right  hand,  and  tap  gently  for  superficial  structures,  for  deeper  structures 
more  strongly. 

MEASUREMENTS  are  used  but  little  in  our  examination  of  the  abdomen, 
but  you  can  take  the  umbilicus  as  a  fixed  point  and  measure  from  it  to 
the  anterior  superior  spines  of  the  ilia,  to  the  end  of  the  ensiform  car- 
tilage, or  to  the  symphysis  pubes. 

AUSCULTATION  is  made  little  of  in  the  books.  However,  I  think  we 
use  it  more  than  the  old  profession;  it  is  said  it  is  of  little  use.  Dr.  Harry 
Still  uses  it  very  frequently  in  cases  of  liver  trouble.  He  says  if  he  finds 
a  gurgling  sound  over  the  liver,  there  is  trouble  there.  That  gurgling 
sound  indicates  that  there  is  an  obstruction  to  the  portal  circulation.  I 
have  often  been  able  to  hear  this  gurgling  sound.  It  will  be  puiet  for 
a  while  and  then  you  will  hear  a  gurgling,  and  it  will  be  quiet  again 
and  you  will  hear  the  gurgling  again.  I  am  aware  you  might  confuse  this 
with  the  bubbling  of  gases  in  the  stomach  and  intestines,  but  you 
will  have  to  learn  by  general  indications  what  the  probabilities  are. 
However,  I  thing  auscultation  in  that  way  over  the  liver  is  useful  to  xis 
as  Osteopaths.  Auscultation  is  also  employed  to  hear  the  fetal  sounds  in 
pregnancy,  we  will  take  that  up  later.  Remember  also  that  you  must 
take  into  consideration  the  conformation  of  the  spine,  thorax  and  pelvis ; 
take  all  these  parts  which  will  in  any  way  affect  the  abdomen  into  con- 
sideration in  your  examination. 

It  is  difficult  to  say  just  how  to  give  a  GENERAL  TREATMENT  FOR  THE 
ABDOMEN,  because  we  usually  treat  there  for  a  specific  object.  However, 
as  far  as  a  general  treatment  would  go  in  the  abdomen,  it  would  relax  the 
walls.  I  would  lay  my  hands  on  the  abdomen  firmly;  I  would  not  take 
the  tips  of  my  fingers,  I  would  not  dig,  I  would  keep  my  hands  straight; 
you  know  the  importance  of  that.  Thus  you  can  thoroughly  relax  all 
the  surface  of  the  abdomen.  We  know  this  is  a  very  effective  move- 
ment; it  is  hard  to  explain.  As  I  said  at  the  last  lecture,  I  believe  that 


EXAMINATION    AND   TREATMENT   OF   THE    ABDOMEN.  175 

the  movements  there  stimulate  the  nervous  mechanism  in  the  abdomen 
more  than  anything  else;  and  mechanically  we  cannot  help  but 
work  the  blood  to  the  parts.  It  is  very  beneficial.  It  is  recom- 
mended by  physicians  in  general  just  to  tap  the  abdomen  lightly  all  over. 
The  masseur  works  the  abdomen  considerably  in  case  of  constipation, 
and  that  mechanically  excites  a  flow  of  blood.  That  is,  if  it  is  mechan- 
ical, but  it  is  hard  to  believe  it  is  very  largely  in  that  way.  There  is 
also  another  movement  we  might  include  in  the  ge  icral  treatment  of 
the  abdomen,  that  is,  a  lifting  up  motion ;  you  can  thrust  your  hands 
down  in  deep  in  the  iliac  fossa,  and  raise  everything  there.  You  can 
in  that  way  raise  the  uterus,  bladder  and  bowels.  That  is  an  excellent 
method  of  treatment,  and  has  been  used  with  great  success. 

Next,  as  to  examining  and  treating  the  important  organs  contained 
within  the  abdomen.  First,  the  STOMACH.  It  is  hard  to  confine  your- 
self to  a  particular  part.  The  stomach,  for  instance,  gives  symptoms  in 
all  parts  of  the  body.  We  should  notice  the  face,  the  expression  and 
the  complexion,;  there  may  be  lack  of  color,  a  yellow  or  clay  colored 
complexion.  Also  notice  the  eyes,  the  odor  of  the  breath,  the  appear- 
ance of  the  tongue.  All  these  things  are  indicative  in  troubles  of  the 
stomach.  Also  vomiting,  the  belching  of  gas,  and  so  on.  But  these 
things  are  so  familiar  to  you  that  I  need  but  mention  them  to  you  in 
the  treatment  of  the  subject  in  this  way.  However,  more  particularly 
as  to  the  stomach  locally.  You  have  the  point  already  that  you  can  see 
by  inspection  whether  or  not  it  is  distended.  You  can  also  notice  by 
palpation  whether  or  not  it  be  enlarged,  by  percussion  whether  or  not 
such  be  caused  by  solids,  fluids  or  gases.  Now,  in  treatment  of  the  stom- 
ach, you  know  already  that  our  chief  treatment  is  over  the  splanchnics; 
I  have  indicated  to  you  the  manner  in  which  we  treat  the  splanchnics. 
We  also  go  to  the  solar  plexus,  treating  by  pressing  deeply  below  the 
end  of  the  sternum,  over  the  pit  of  the  stomach,  a  pressure 
of  five,  six  or  eight  pounds,  and  thus  impinge  upon  the  solar  plexus. 
You  thus  get  an  effect  on  the  stomach,  since  the  plexus  has  control  of 
the  coeliac  blood  supply,  as  well  as  various  other  blood  vessels  in  the 
abdomen.  Sometimes  we  treat  the  stomach  mechanically  by  raising  the 
ribs,  as  we  would  on  the  right  side  in  liver  trouble.  It  is  the  usual  mo- 
tion of  raising  the  ribs.  Or  you  can  set  the  patient  up,  have  him  take 
a  deep  breath,  and  put  the  fingers  in  gently  under  the  ribs  and  raise 
upward  and  outward  as  he  exhales,  thus  freeing  the  parts  in  that  way.  In 
any  treatment  we  wish  to  reach  the  splanchnics.  the  solar  plexus,  and 
an  important  point  in  the  neck.  We  reach  the  vagus  along  the 
sides  of  the  neck  and  behind  the  clavicle,  where  it  passes  be- 
hind the  first  rib.  At  the  atlas,  it  is  said  a  displacement  to  the  right  will 
interfere  with  the  right  vagus.  In  the  case  of  nausea  we  inhibit  upon 


176  TREATMENT   OF   THE   STOMACH. 

the  left  side  between  the  fourth  and  fifth  ribs.  You  know  how  to  find 
these  interspaces.  I  thrust  my  thumb  into  that  interspace.  The  spine 
of  the  scapula  is  opposite  the  third,  then  coming  down  a  little  over  an 
inch,  you  will  readily  be  able  to  find  where  the  interspace  is;  then  you 
must  raise  the  arm  a  little,  just  enough  to  relax  those  parts,  and  dirust 
the  thumb  deeply  in  that  interspace.  That  is  one  way  of  treating  nausea, 
but  it  depends  upon  the  cause.  I  have  had  cases  of  nausea  in  which  that 
would  not  succeed,  the  pressure  gave  no  relief,  but  general  work  upon 
the  splanchnics  would  give  relief.  That  was  a  case  where  the  patient 
was  easily  susceptible  to  congestion  of  the  stomach,  and  such  treat- 
ment, coupled  with  treatment  of  the  vagi  in  the  neck,  would  always  give 
relief.  Treat  in  general  the  back  from  the  third  or  fourth  dorsal  down 
to  the  tenth,  eleventh,  or  twelfth.  Displacement  of  ribs  may  cause  the 
same  trouble,  and  you  may  also  find  a  contracture  along  the  spine  on 
either  side,  which  will  cause  trouble  with  the  stomach.  I  treated  a  case 
some  time  ago  in  which  the  only  lesion  I  could  find  was  a  contracture 
of  the  muscles  on  both  sides;  there  was  a  little  heaviness  of  the  stomach, 
which  disappeared  on  treatment.  You  may  find  exquisite  tenderness 
over  the  region  of  the  stomach,  and  you  can  see  on  pressure  whether 
or  not  that  be  nervous  or  inflammatory.  When  you  have  gas  in  the 
stomach  it  shows  there  is  a  lack  of  life  in  such  a  way  as  to  allow7  the 
food  not  to  be  digested  and  passed  on  in  the  usual  way,  but  to  be  retained 
and  thus  to  ferment  and  form  gas.  It  is  said  to  free  the  stomach  of  its 
contents,  to  inhibit  the  pneumogastric  between  the  fourth  and  fifth  ribs, 
as  I  have  shown  you,  and  in  that  way  you  relax  the  pylorus  and  allow 
the  food  and  contents  to  pass  off.*  Or  you  can  also  do  the  same  thing 
by  mechanical  work.  I  thrust  my  hand  down  upon  the  left  ribs  and  work 
toward  the  large  end  of  <the  stomach;  I  bring  pressure  gradually  toward 
the  pyloric  end,  in  that  way  you  can  force  onward  the  contents  of  the 
stomach.  You  work  thus  over  the  ribs;  you  can  press  the  ribs  down, 
and  you  can  also,  in  the  median  line,  work  very  carefully  on  the  abdo- 
men; you  thus  work  the  gas  or  liquid  from  the  stomach. 

This  deep  pressure  over  the  solar  plexus,  as  I  have  already  shown, 
is  said  to  be  very  efficient  in  case  of  bloating  with  gas.  In  some  way 
the  stimulation  of  the  plexus  allows  the  gases  to  be  condensed. 
The  ninth  and  twelfth  ribs  on  the  left  side  have  been  found 
displaced  in  some  cases.  In  cases  of  pregnancy,  difficult  menstruation  or 
such  troubles,  you  will  frequently  find  a  sick  stomach.  That  is  reflex. 
To  treat  a  sick  headache  which  is  caused  from  the  stomach,  you 
must  first  apply  your  treatment  to  the  stomach,  and  thoroughly  stimu- 
late the  parts  there  before  attempting  to  work  on  the  head.  In  case  of 

*See  Appendix  18. 


TREATMENT    OF   THE    LIVKR.  177 

I     '• 

female  troubles,  you  may  give  relief  there,  and  it  is  well  to  do  so,  but  of 
course  you  must  work  upon  the  local  trouble  at  its  appropriate  centers 
to  relieve  it. 

Now,  as  to  the  LIVER.  First,  its  examination ;  you  cannot  see 
anything  by  mere  inspection;  the  best  way  is  to  percuss  the  region  of 
the  liver.  If  you  find  behind  the  linea  alba  that  the  left  lobe  comes  down 
as  much  as  three  inches,  the  liver  is  either  prolapsed  or  enlarged,  and 
you  will  have  to  determine  which  is  the  case.  By  percussion  along  the 
lower  edge  of  the  ribs,  and  up  over  the  ribs  as  high  as  about  an  inch 
below  the  nipple  you  can  make  out  the  outline  of  the  liver.  You  will 
also  frequently  find  that  it  is  quite  tender,  and  it  becomes  extremely 
so  in  some  cases.  Dr.  Harry  Still  says  that  in  case  the  liver  is  extremely 
tender  he  always  looks  for  diarrhea  alternating  with  constipation.  The 
easiest  place  to  find  whether  or  not  the  liver  is  tender  is  in  the  median 
line  behind  the  linea  alba.  Of  course  the  liver  is  complicated  with  gen- 
eral troubles,  as  for  instance,  in  constipation  and  diarrhoea ;  these  two 
things  indicate  derangement  of  the  liver.  In  diseases  of  the  liver  you 
will  frequently  notice  yellow  splotches  upon  the  skin,  perhaps  on  the 
face,  perhaps  over  the  abdomen;  you  will  find  a  rushing  of  blood  to 
the  head,  double  vision,  or  day  blindness.  You  must  learn  in  general 
what  the  complications  are,  when  the  liver  is  deranged. 

I  have  noted  the  fact  that  auscultation  is  frequently  used  in  examina- 
tion of  the  liver.  Just  place  the  ear  very  lightly  over  the  region  of  the  liver, 
at  the  edge  of  the  liver  you  will  be  able  to  make  out  a  gurgling  if  there 
be  such  there.  Now,  as  to  the  treatment  of  the  liver  itself.  I  have  al- 
ready shown  you  how  we  treat  it — the  raising  of  the  ribs  as  shown;  or 
have  the  patient  take  a  deep  inspiration,  and  then  raise  the  points  of  the 
ribs  upon  expiration.  Dr.  Harry  Still  frequently  employs  that  method — 
reaching  under  the  tips  of  the  ribs  and  raising  them  upward  and  outward. 
Of  course  you  will  have  to  be  careful  in  doing  that.  We  also  work  upon 
the  liver  frequently  in  this  way:  you  can  place  one  hand  beneath  and  thus 
raise  the  side  of  the  chest  toward  you,  and  with  the  other  hand  press  down 
with  the  flat  of  the  fingers  against  the  liver.  Thus  you  can  press  the 
ribs  down,  and  this  motion  is  very  good. 

I  explained  what  I  believed  to  be  the  theory  of  such  work  the  other 
day.  In  treating  the  liver  we  must  remember  that  there  are  vaso- 
motor  fibres  in  the  pneumogastric,  and  we  must  not  omit  to  treat 
it.  We  afsb  treat  the  splanchnics,  as  they  contain  the  sympathetic  sup- 
ply; also  the  solar  plexus.  -Those  are  the  chief  points  for  reaching  the 
blood  and  nerve  supply  of  the  liver.  Also  the  point  that  I  gave  you, 
upon  each  side  of  the  umbilicus,  it  is  said  that  pressure  here  app'ied  not 
too  deeply,  a  fairly  firm  pressure,  will  reach  those  centers  and  influence, 


178  TREATMENT   OF   THE   LIVER. 

first,  the  kidneys ;  second,  the  liver ;  and  third,  the  bowels.  You  can  get 
an  influence  upon  all  those  organs  in  that  way. 

The  GALL-BLADDER  AND  DUCT  are  extremely  important  to  us.  As  I  have 
said,  the  gall-bladder  is  behind  a  portion  of  the  liver  at  the  point  of  the 
ninth  rib  on  the  right,  but  we  can  get  indirect  pressure  upon  it  by  work- 
ing up  under  the  point  of  the  ribs;  for  instance,  you  can  sometimes 
feel  the  prominence  made  by  the  fundus.  The  first  thing  in  working  upon 
the  gall-bladder  is  to  work  against  the  fundus,  and  we  can  work  upon  it  by 
working  up  under  the  ends  of  the  ribs.  The  duct  we  have  already  spoken 
of,  it  lies  upon  the  right  in  a  reversed  "S,"  its  upper  limb  being  just 
over  the  umbilicus,  to  the  left,  and  the  lower  limb  of  the  "S"  around 
the  umbilicus  to  the  right  where  it  empties  into  the  duodenum.  Since 
the  gall-bladder  and  its  ducts  are  lined  with  mucous  membrane, 
and  since,  like  mucous  mebranes  in  other  parts  of  the  'body,  it  is  liable 
to  catarrh,  it  follows  that  catarrhal  inflammation  may  sometimes  travel 
from  the  pharynx,  through  the  oesophagus,  stomach  and  intestines  and 
up  into  the  gall-bladder.  You  will  then  have  an  increased  secretion  of 
mucous  in  the  gall-bladder  and  duct,  and  may  have  a  mucous  plug 
shutting  up  that  duct,  resulting  in  jaundice.  Or  you  may  have  a  gall- 
stone formed,  said  to  be  a  precipitation  of  the  cholesterine  of  the  bile: 
th'is  solidifies  and  closes  the  duct.  In  treating  for  gall-stones  we  work 
as  I  have  shown  you,  against  the  fundus  of  the  bladder  and  along  the 
duct,  simply  trying  to  force  them  out.  Sometimes  they  are  quite  hard, 
and  at  times  they  are  quite  soft  and  can  be  crushed  in  the  duct;  this 
has  to  be  done  without  any  violence,  however.  It  is  said  that  in  treat- 
ing for  gall-stones,  you  should  not  end  your  treatment  without  raising 
the  ninth,  tenth  and  eleventh  ribs  on  the  left  side  for  the  spleen;  that 
stimulation  of  the  spleen  seems  to  prevent  their  formation,  and  results 
gotten  there  seem  to  prove  that  argument. 

Q.  In  case  you  were  treating  the  vagi  in  the  neck  and  the  patient 
should  be  taken  with  a  nervous  chill  or  something  of  that  kind,  at  what 
point  would  you  treat  to  counteract  that? 

A.  I  would  treat  along  the  spine,  a  general  treatment,  stimulating 
also  the  heart  and  lungs  to  stimulate  the  circulation. 


LECTURE  XXV. 

At  the  last  lecture  I  took  up  the  examination  and  treatment  of  the 
abdomen  and  its  contents,  first  showing  you  how  we  treat  to  affect  the 
abdomen  in  a  general  way,  and  then  I  started  to  take  up  the  contents 
of  the  abdomen  one  after  another.  I  will  also  take  up  the  consideration 
of  the  pelvis  to-day. 


NERVE  CENTERS  AND  CONNECTIONS  OF  THE  PELVIC  OUUANS.     179 

I.  SOME  NERVE  CONNECTIONS  AND  CENTERS  FOR 
THE  INTESTINES  AND  PELVIC  CONTENTS.— I  have  already 
mentioned  some  centers,  in  the  list  given,  and  we  should  always  con- 
sider those  centers  along  -the  spine  in  connection  with  the  different 
parts.  There  are  certain  vaso-motor  fibres  noted  in  Howell's  Text 
Book;  First,  for  the  external  genital  organs  there  are  two  groups,  one 
coming  from  the  lumbar  region,  and  the  other  from  the  sacral  region. 
Those  of  the  lumbar,  from  the  second,  third,  fourth  and  fifth  lumbar 
nerves,  running  forward  in  the  white  rami  communicantes.  They  pass 
through  the  pelvic  plexus  and  pudic  nerve  and  thus  reach  their  ter- 
mination. You  will  see  later  that  this  pudic  nerve  is  important  to  us  in 
our  treatment;  you  know  it  contains  some  vaso-motor  fibres  for  the 
external  genitals.  As  for  the  sacral  group,  these  leave  the  anterior  roots 
of  the  nerves  in  the  sacral  region.  A  stimulation  here  causes  .1  dilation 
of  the  vessels  of  the  external  genitals.  As  to  the  internal  generative 
organs,  vaso-constrictors  for  the  Fallopian  tubes,  uterus,  and  vagina  in 
the  female,  and  for  the  seminal  vesicles  and  the  vasa  deferentia  in  the 
male,  are  contained  in  the  sacral  nerves.  Also  we  get  some  fibres  from 
the  second,  third,  fourth  and  fifth  lumbar  nerves,  just  as  we  had  vaso- 
motor  fibres  for  the  external  genitals.  We  need  to  know  the  following 
points:  That  the  second,  third,  fourth  and  fifth  are  the  same  for  the 
external  and!  internal  genitals;  that  we  get  vaso-motor  fibres  from  both; 
that  we  also  work,  as  you  will  see  later,  in  consideration  of  the  pelvic 
contents,  frequently  upon  the  sacral  region,  springing  the  sacrum,  re- 
laxing the  ligaments  about  it,  and  also  stimulating  the  peripheral  term- 
inations of  the  nerves  in  the  muscles  along  the  sacral  region.  It  is  said 
that  the  first  point  to  which  one  should  go  in  treatment  of  female 
troubles  is  the  fifth  lumbar;  that  that  is  the  important  point,  not  particu- 
larly an  important  center,  but  the  place  where  it  seems  a  displacement 
is  likely  to  occur.  Then,  too,  you  know  that  that  is  the  center  for  the 
hypogastric  plexus.  The  next  important  point  is  the  second  lumbar, 
which  is  the  center  for  blood-supply  to  the  uterus.  After  that,  in  treat- 
ment of  female  troubles,  the  next  important  point  is  between  the  tenth 
and  eleventh  dorsal  vertebrae,  the  blood-supply  to  the  ovaries. 

Hilton  makes  a  point  that  the  muscular  abdominal  walls,  the  peri- 
toneum lining  these  walls,  and  the  skin  over  them,  are  supplied  by 
branches  of  the  same  nerves,  as  we  have  already  mentioned  the  point 
he  makes  that  a  joint,  the  muscles  moving  the  joint,  and  the 
skin  covering  those  muscles,  are  all  supplied  by  branches  of  the 
same  nerve.  Hence,  it  is,  he  says,  that  retraction  of  the  abdominal  wall 
and  great  tenderness  of  the  skin  over  the  abdomen  is  found  in  cases  of 
peritonitis,  the  inflammation  reaching  the  terminal  filament  in  the  peri- 
toneum, extending  thus  from  the  branches  irritated,  the  sensory  branches 


180  NERVE   CENTERS   AND    CONNECTIONS   OF   THE   PELVIC   ORGANS. 

to  the  motor  branches,  causing  the  abdominal  walls  to  contract,  influ- 
encing also  the  external  cutaneous  branches,  resulting  in  a  feeling  of  pain 
upon  touching  the  abdomen.  That  brings  to  mind  the  point  that  has 
already  been  mentioned,  and  which  was  brought  up  in  clinics  not  long 
since.  The  question  was,  can  you  impinge  upon  the  sensory  part  of  a 
nerve  and  thus  affect  its  motor  fibres.  I  think  that  such  points  as  this 
answer  that  very*  clearly.  Hilton  also  instances  a  case  of  peritonitis,  in 
which  the  cause  was  obscure.  It  was  net  severe,  but  it  was  hard  to 
tell  at  first  that  it  was  peritonitis.  The  patient  had  been  having  pain 
in  the  abdomen,  it  was  bilateral,  there  was  no  heat  at  the  part;  he  there- 
fore decided  that  the  cause  was  either  central  or  double,  and  since  there 
was  no  heat  there,  he  examined  for  spinal  trouble.  He  could  not  find 
any  evidence  of  disease  of  the  spine;  he  then  made  his  examination  for 
fluid  in  the  abdominal  cavity  and  found  that  there  was  fluid  irritating 
the  nerves  and  causing  this  pain  upon  the  abdomen. 

In  considering  the  pelvis,  I  thought  it  would  be  interesting  to  bring 
out  some  further  points  considering  nerve  connections  there.  I  noted 
the  point  the  other  day  that  in  disease  of  the"  uterus,  ovaries,  etc.,  the 
sympathetic  filaments  supplying  these  parts  carry  the  irritation  back  to 
the  spinal  nerves,  and  thus  it  may  go  down  the  sciatic,  or  may  influence 
the  muscles  at  the  lower  part  of  the  spine,  causing  lameness  there.  A 
further  point  is  noted  with  considerable  interest,  and  it  may  be  useful 
to  us  in  many  cases.  Hilton  noted  a  case  in  which  a  gentleman  came  to 
him  with  what  he  supposed  to  be  trouble  of  the  bladder  and  urethra. 
He  had  pain  externally  in  the- genitals  on  one  side,  and  he  traced  the 
pain  very  definitely  along  the  peripheral  branch  of  the  pudic  nerve, 
along  the  ramus  of  the  pubis  and  ischium  to  the  genitals.  Hilton  traced 
the  nerve  carefully  back  and  discovered  at  the  tuberosity  of  the  ischium 
on  the  side  affected  a  thickening  of  the  tissues.  The  gentleman  had  been 
used  to  sitting  upon  a  hard,  uneven  seat,  and  gradually  there  had  formed 
a  thickening  of  the  tissues  which  had  impinged  upon  the  nerves  and 
caused  this  pain.  As  you  know,  there  is  a  bursa  over  the  tuber- 
osity of  the  ischium  for  its  protection,  and  irritation,  or  sitting 
upon  a  hard  seat,  or  weight  unevenly  distributed,  will  cause  similar 
troubles.  It  may  be  an  Osteopath  would  go  back  to  the  spine,  but  if 
he  did  not  find  a  lesion  there  the  next  best  thing  would  be  to  go  to  the 
nerve,  and  see,  especially  at  the  tuberosities,  if  there  was  not  some  trouble. 

II.  LANDMARKS  ABOUT  THE  PELVIS  AND  PERINEUM:— 
You  are  all  familiar  with  the  location  of  the  anterior  superior  spine  of  the 
ilium.  It  is  used  by  surgeons  as  a  point  from  which  to  measure  the- 
length  of  the  limbs,  which  you  know  is  quite  a  hard  thing  to  do  success- 
fully, so  many  things  make  changes  in  the  length  of  the  leg.  Holden, 
however,  says  he  finds  it  more  reliable  to  take  a  tape  line  and  have  the 


LANDMARKS   ABOUT  THE   PELVIS   AND    PERINEUM.  181 

patient  hold  it  between  his  teeth,  then  measure  a  fixed  point  on  the  limb 
somewhere,-  (he  measures  to  the  inner  malleolus)  not  swinging  the  tape 
from  one  side  to  the  other,  but  making  an  independent  measurement 
each  time.  You  will  find  that  in  work  upon  the  pelvis,  and  in  examining 
the  legs  you  will  have  to  see  that  the  patient  lies  perfectly  straight  upon 
the  table.  One  good  way  is  to  ascertain  whether  or  not  a  line  drawn 
transversely  between  the  anterior  superior  spines  is  at  right  angles  to 
the  axis  of  the  body;  you  will  have  to  see  that  the  patient  is  perfectly 
straight.  It  is  also  helpful  in  making  a  diagnosis  of  hip-joint  disease, 
or  disease  about  the  hip-joint,  to  place  the  thumbs  firmly  upon  the 
spines,  one  upon  each,  then  grasp  beneath  the  trochanters  with  the  finger, 
and  you  will  be  able  to  examine  in  that  way  for  two  things:  whether 
the  two  sides  are  alike,  and  at  the  same  time  you  can  press  backward  upon 
the  spine ;  a  tenderness  behind  gives  evidence  of  disease  in  the  sacro-iliac 
synchondrosis. 

The  spine  of  the  pubis  is  also  familiar  to  you  in  its  location.  It  is  not 
always  easy  to  find;  sometimes  you  can  find  it  by  pushing  the  lower 
abdominal  skin  backward  toward  the  direction  of  the  spine;  if  not  suc- 
cessful, then  by  abducting  the  limb  slightly,  causing  the  adductor  longus 
to  be  tensed ;  you  can  feel  its  attachment  to  the  spine.  Frequently  it 
is  difficult  to  distinguish  between  two  kinds  of  hernia,  the  inguinal  and 
femoral,  but  is  said  that  in  case  of  inguinal  hernia  the  spine  of  the  pubis 
is  on  the  outside  of  the  neck  of  the  sack,  while  in  case  of  femoral  hernia 
it  is  on  the  inside.  That  may  be  a  helpful  point. 

The  perineum  has  a  ligamentous  and  osseous  boundary ;  it  is  bounded 
by  the  rami  of  the.  pubes  and  ischia,  the  tuberosities  of  the  ischia.  the 
great  sacro-sciatic  ligaments,  and  the  tip  of  the  coccyx  behind.  It  is 
important  in  our  practice,  I  have  not  seen  the  point  mentioned  in  the 
books,  that  we  should  note  the  shape  of  the  perineum.  In  the  normal, 
healthy  perineum  there  is  a  slight  bowing  upward  to  ho]d  up  the  pelvic 
contents,  in  disease  there  may  be  a  relaxation  of  the  perineum  and  a 
dropping  down  of  the  contents,  causing  a  bulging  of  the  perineum. 
Of  course  the  bulging  is  slight  whether  it  is  normal  or  abnormal,  but 
it  is  important;  those  things  sometimes  cause  a  great  deal  of  trouble, 
even  though  the  variation  from  the  normal  position  may  be  slight.  In 
treating  such  a  case  we  go  to  the  pudic  nerve  where  it  crosses  the  spine 
of  the  ischium,  stimulating  just  where  it  crosses  the  spine,  and  its  perineal 
branches  running  to  the  perineum  cause  a  contraction;  also  by  stimulat- 
ing the  lower  sacral  nerves,  causing  a  contraction  of  the  coccygeus 
muscle,  we  help  it  to  raise  the  bowel  and  the  pelvic  contents. 

Along  the  region  of  the  sacrum  we  find  the  posterior  superior  spines 
of  the  ilia.  They  are  on  a  line  which  would  pass  horizontally  through 
the  second  sacral  spine,  anJ  they  also  mark  the  middle  point  of  the  sacro- 


182  EXAMINATION    AND   TREATMENT   OF   THE   INTESTINES. 

iliac  synchondrosis.  We  can  find  opposite  them  the  spines  of  the  sac- 
rum, down  to  the  last,  and  two  tubercles  upon  the  last  just  where  it 
ends.  The  third  sacral  spine  it  is  said  is  the  limit  of  the  extent  of  the 
membranes  of  the  cord  in  the  spinal  canal  and  of  the  presence  of  the 
cerebro-spinal  fluid  in  the  canal. 

The  prominence  of  the  gluteal  muscles  often  becomes  significant.  That 
is,  it  is  said  that  in  persons  of  ill  health  these  muscles  become  relaxed  and 
flaccid,  and  that  wasting  upon  one  side  is  an  early  symptom  of  hip-joint 
disease,  which  is  very  difficult  to  diagnose.  The  fold  of  the  buttock  is  the 
name  given  to  the  line  below  the  edge  of  the  gluteus  maximus  muscle, 
between  it  and  the  upper  back  part  of  the  thigh,  and  it  is  said  that  in 
this  fold  is  the  easiest  place  to  bring  pressure  upon  the  great  sciatic 
nerve.  Taking  a  point  between  the  trochanter  and  the  tirberosity  of  the 
ischium,  and  pressing  deeply,  rather  nearer  the  tuberosity  than  the 
trochanter,  you  can  impinge  upon  the  nerve.  Often  a  person  sitting 
sidewise  will  have  the  leg  become  numb  because  of  impingement  upon 
the  nerve;  you  may  sit  upon  the  edge  of  a  bench  and  injure  this  nerve 
so  as  to  cause  sciatica. 

A  line  drawn  from  the  posterior  superior  spine  of  the  ischium  to  the 
top  of  the  trochanter,  when  the  thigh  is  rotated  forward,  marks,  at  the 
junction  of  the  upper  with  the  middle  two-thirds,  the  emergence  of  the 
gluteal  artery  from  the  great  sacro-sciatic  notch,  and  it  is  at  that  point 
that  you  can  determine  the  top  of  the  notch.  The  pudic  nerve  and  artery,  as 
you  know,  both  cross  the  spine  of  the  ischium.  This  is  located  by  draw- 
ing a  line  from  the  same  point,  the  posterior  superior  spine  of  the 
ischium,  to  the  outer  side  of  the  tuberosity  of  the  ischium,  then  taking 
the  junction  of  its  outer  and  middle  thirds,  you  have  where  this  vessel 
crosses  the  spine,  and  there  you  can  impinge  upon  it.  The 
nerve  a-ccompanies  the  artery,  and  that  is  an  important  point  to  the 
Osteopath,  for  there  you  can  stimulate  that  nerve  and  cause  contrac- 
tion of  the  perineum.  The  point  is  mentioned  that  modern  methods 
of  sitting,  enjoying  one's  self  in  an  easy  chair,  or  upon  soft  cushions 
and  the  like,  causes  the  parts  to  be  supported  more  by  the  soft  parts 
about  the  hips,  so  that  pressure  could  thus  be  brought  upon  these  blood 
vessels,  especially  the  pudic,  and  that  a  hard  chair  is  much  more  health- 
ful. Upon  the  condition  of  these  nerves  depends  the  blood  supply  to 
the  interior  pelvic  organs.  Pressure,  brought  by  sitting,  upon  these 
vessels  determines  the  flow  into  the  pelvis  and  is  a  fruitful  source  of 
uterine  and  pelvic  disorders. 

III.  EXAMINATION  AND  TREATMENT  OF  ABDOMINAL 
CONTENTS. — (Continued.) — As  to  how  to  diagnose  troubles  of  the  intes- 
tine, you  will  learn  that  better  in  symptomatology,  when  you  come  to  the 
special  diseases.  However,  I  can  show  you  something  of  the  methods  em- 


EXAMINATION    AND   TREATMENT    OP    THE    INTESTINES.  183 

ployed.  It  is  obvious  that  when  you  have  a  case  of  constipation,  diarrhoea, 
flux  or  anything  of  that  kind,  where  the  trouble  is.  The  nerve  supply  for 
the  intestine,  as  you  know,  is  through  the  sympathetic*  from  the  upper 
dorsal  down;  that  is,  from  the  third  dorsal  down,  because  we  get  the 
vaso-motors  to  the  mesenteric  vessels  from  the  splanchnics,  and  we  reach 
the  sympathetic  connection  all  the  way  down  the  spine.  I  have  already 
shown  you  how  to  treat  those  parts.  We  also  reach  it  by  working  on 
the  solar  plexus,  and  you  can  get  an  immediate  effect  by  working  upon 
the  centers  either  side  of  the  umbilicus.  In  all  these  ways  we  may  reach 
the  intestine.  *Stimulation  of  the  sympathetics  will  inhibit  the  vermicu- 
lar motion  of  the  bowels,  while  stimulation  of  the  pneumogastric  will  in- 
crease the  motion.  You  know  that  in  working  upon  the  region  of  the  intes- 
tines we  also  work  upon  Auerbach's  and  Meissner's  plexuses.  There  is  a 
treatment  that  we  use  sometimes  in  case  of  constipation,  or  other  trouble 
with  the  bowels,  that  is,  we  begin  at  the  left  iliac  fossa,  and  by  deep  pres- 
sure over  the  line  of  the  colon,  work  gradually  upward  along  the  left  lum- 
bar region  where  the  intestine  runs  over  the  kidney,  then  across  just  above 
the  umbilicus,  and  down  the  right  lumbar  region;  that  is,  we  work  there 
largely  for  mechanical  effect,  to  soften  the  fecal  matter  and  work  it  out- 
ward as  we  go,  beginning  near  the  orifice.  Of  course,  it  is  impossible 
not  to  impinge  upon  the  nerve  plexuses  and  not  to  influence  Auerbach's 
and  Meissner's  plexuses  in  working  upon  the  intestines.  You  will  very 
frequently  meet  cases  of  cramps  and  diarrhoea.  They  are  not  limited 
to  particular  seasons  of  the  year.  I  have  found  cases  of  bad  cramps  in  the 
intestines  where  it  was  almost  periodic,  you  might  say,  it  came  on  every 
two  or  three  months.  After  some  indiscretion,  as  over-eating  or  eating  of 
too  rich  food  the  patient  would  have  those  attacks.  The  spasm,  as  near 
as  I  could  make  out,  is  most  liable  to  occur  in  the  transverse  colon ;  it 
starts  there  first,  and  from  that  point  the  irritation  will  pass  down  through 
the  bowel,  and  the  next  morning  or  the  second  morning  you  will  have 
tenderness  and  pain  down  in  the  region  of  the  right  iliac  fossa.  It  has 
been  my  experience  that  it  takes  that  course;  from  there  it  will  spread 
over  the  bowel,  and  you  will  have  an  inflammation,  as  shown  by  the  fact 
that  the  patient  usually  passes  mucous  upon  convalescence.  This  trouble 
can  be  very  readily  stopped.  It  is  done  by  inhibiting  the  splanchnics;  you 
can  have  the  patient  sit  upon  axhair,  and  hold  closely  all  along  the  region 
of  the  splanchnics,  by  a  deep  pressure,  hold  at  each  point  for  a  minute  or 
two  and  you  will  be  able  in  that  way  to  stop  the  spasm.  I  have  seen 
it  disappear  in  a  very  short  time.  The  same  thing  can  be  done  by  placing 
one  knee  along  the  splanchnics  and  drawing  the  arms  up  and  back.  That 
brings  deep  pressure,  and  very  forcible,  against  the  splanchnics,  and  in- 


*See  Appendix  19. 


184  EXAMINATION   AND  TREATMENT   OF   THE    INTESTINES. 

hibits  them.  Particularly  it  is  the  upper  splanchnics  we  wish  to  reach, 
but  it  does  no  harm  to  work  on  down  the  spine.  It  is  not  a  bad  idea  to 
adopt  a  twisting  motion,  because  if  there  is  a  tightening  and  irritation 
of  those  nerves,  you  will  be  able  to  relax  them  in  that  way,  and  I  have 
been  able,  in  that  way,  to  get  very  good  results  with  such  trouble. 

There  is  another  thing  that  comes  to  us  very  commonly,  and  that  is 
flux  and  diarrhoea.  The  center  for  the  bowels  which  we  wish  to  reach  in 
such  cases  is  opposite  the  lower  two  ribs  on  each  side,  where  we  work  by 
inhibiting,  by  getting  deep  pressure,  just  as  I  have  shown  you.  Have  the 
patient  sitting  up,  and  you  can  place  your  knee  against  the  eleventh  and 
twelfth  ribs,  close  to  the  spine  on  one  side,  and  pull  the  arms 
up  and  back,  and  then  against  the  other  side;  you  can  thus 
inhibit  the  peristalsis.  It  is  undoubtedly  through  the  sympathetic 
connection  and  inhibition  of  the  sympathetics.  I  never  omit  in 
such  cases  to  spring  the  spine,  and  to  spring  it  strongly ;  that  is  one 
of  the  cases  where  we  have  to  give  a  strong  treatment,  so  I  have  the 
patient  on  the  side,  reach  under  the  spine  and  spring  the  column  toward 
me  strongly,  all  along  the  lumbar  region.  It  is  very  helpful  also  to  adopt 
this  method  in  such  cases:  with  the  patient  upon  his  side,  have  the  thighs 
bent  up,  get  a  good  hold  against  the  sacro-iliac  articulation,  and  spring 
enough  to  raise  the  patient  from  the  table.  I  think  you  can  see  from  the 
motions  I  have  given  you  about  what  you  can  do  in  such  cases.  Also  in 
such  cases  never  forget  to  work  upon  the  liver;  I  have  already  shown  you 
how  to  reach  that,  and  influence  it,  especially  the  flow  of  the  bile.  It  does 
not  make  much  difference  whether  the  patient  is  constipated  or  whether 
he  has  flux  or  diarrhea,  the  presence  of  bile  in  the  intestines  is  undoubted- 
ly helpful.  In  cases  of  constipation,  Doctor  Still  says  the  bile  is  Nature's 
aperient,  and  that  it  helps  to  stimulate  the  peristalsis.  In  the  other  case 
the  action  of  the  bile  in  the  intestine  seems  to  be  such  as  to  allay  the  irrita- 
tion or  the  inflammation.  It  amounts  to  restoring  the  normal ;  in  one  case 
you  have  a  lack  of  bile,  and  the  normal  action  of  the  bowel  seems  to  be 
dependent  upon  it  for  stimulation.  In  the  other  case  you  must  work  to 
cause  a  flow  of  bile  also.  Just  why  it  works  differently  it  is  very  hard  to 
explain,  unless,  as  I  say,  it  is  the  normal  condition  of  the  bowel  to  have 
the  bile  present  at  certain  intervals,  and  if  that  bile  is  lacking,  you  may 
have  various  effects.  I  had  a  very  interesting  case  not  long  since,  a  gentle- 
man who  some  years  ago,  I  think  about  three,  had  a  case  of  bowel  trouble, 
diarrhea  and  considerable  trouble  at  that  time.  Since  then  he  had  had 
pain  after  eating,  about  three  hours  after  a  meal,  also  bloody  flux. 
This  had  been  troubling  him  off  and  on  ever  since  he  had  the  old 
trouble.  Upon  examination  the  only  difficulty  that  I  could  find  was  tight- 
ening along  the  lower  lumbar  region,  making  a  smooth  place  in  the  spine, 
which  I  have  already  described  to  you.  Besides  that,  the  eleventh  and 


TREATMENT   OF  THE   INTESTINES.  185 

twelfth  ribs  on  each  side  were  approximated,  so  that  you  could 
feel  but  very  little  interspace  between  them.  In  the  first  treatment 
I  did  all  I  could  to  spring  the  lower  part  of  the  spine  and  to  relax  the 
tissues  in  that  region,  and  also  adopted  motions  already  shown  to  separate 
the  eleventh  and  twelfth  ribs.  After  that  treatment  the  pain  after  eating 
ceased,  and  he  did  not  have  any  return  of  it.  The  next  treatment  was 
given  about  a  week  later,  and  I  repeated  the  same  process  at  that  time. 
Since  then,  at  the  last  information  about  a  week  ago,  he  had  had  no  return 
of  the  trouble,  and  that  was  about  two  weeks  after  the  treatment.  Now, 
that  was  all  very  simple,  it  was  merely  looking  to  see  where  things  had 
departed  from  the  normal,  and  restoring  them  and  relieving  the  tension 
upon  the  parts.  One  thing  that  I  did  in  that  case  was  to  relax  the  liga- 
ments by  springing  the  lumbar  region.  You  will  learn  these  motions  and 
how  to  apply  them.  It  seems  that  in  same  kinds  of  trouble  one  motion  is 
more  efficacious  than  another,  and  you  will  also  find  that  it  varies  with 
your  patient.  I  also,  in  that  case,  took  what  I  call  the  quarter  turn  to 
relax  the  tension  between  those  ribs.  That  is,  I  took  the  legs  of  the 
patient  in  my  arms,  and  turned  him  until  his  body  was  about  three  quar- 
ters off  the  table,  then  let  him  slip  down  and  around,  lifting  him  back  onto 
the  table,  straightening  the  legs.  * 

I  mentioned  the  point  that  a  displaced  coccyx  is  sometimes  the  cause 
of  diarrhea.  There  is  also  another  important  treatment  in  the  case  of  in- 
testinal troubles.  That  is,  you  may  raise  the  intestines  almost  bodily, 
especially  in  cases  where  there  is  a  relaxation  of  the  abdominal  walls, 
where  you  find  the  transverse  colon  descended  below  the  umbilicus,  and 
then  by  pushing  in  deeply  above  the  pubes  you  can  push  upward  and  out- 
ward and  thus  raise  the  abdominal  contents.  Another  motion  is  to  have 
the  patient  lie  on  the  side  and  then  you,  standing  behind  him,  reach  deeply 
into  the  fossa  and  work  in  on  the  right  side  under  the  caecum,  follow  it 
up  and  spread,  and  then  work  in  the  same  way  on  the  Jeft  to  raise 
and  spread  out  the  sigmoid  flexure.  That  is  frequently  a  very  good  way 
in  which  to  treat  troubles  of  the  intestine,  especially  where  you  expect 
any  sort  of  relaxation  allowing  the  bowel  to  drop  in  that  way,  and  that 
is  in  almost  every  case  where  you  have  had  intestinal  trouble  that  has 
been  going  on  for  some  time.  There  is  almost  always  a  relaxation  of  those 
ligaments,  and  prolapse  of  the  bowel.  You  will  remember  that  the  defeca- 
tion center  is  at  the  second  lumbar,  and  Doctor  Still  has  shown  me  a 
good  point  in  how  to  reach  the  second  lumbar.  He  places  the  thumb  of 
one  hand  just  over  the  trochanter  of  the  femur,  or  just  above,  and  then 
finds  the  second  lumbar  by  counting  carefully  up  from  the  fifth  lumbar, 
Jhen.  while  he  presses  upward  the  trochanter  of  the  patient  with  the 
hand  that  is  on  the  hip,  he  presses  inward  with  the  other  hand  and  gives 
a  turn  to  the  second  lumbar.  Then,  taking  the  same  point  for  one  hand, 


186  TREATMENT   OF   THE   INTESTINES— SPLEEN. 

and  reaching  under  and  raising  the  patient's  head  and  shoulders,  he  thus 
very  effectually  relaxes  the  second  lumbar.  You  see,  that  makes  the 
second  lumbar  a  fixed  point,  and  you  swing  the  upper  part  of  the  trunk 
around  it. 

Robinson  makes  quite  a  point  of  the  fact  that  what  he  calls  the  fecal 
reservoir,  viz. ;  the  left  half  of  the  transverse  colon  and  the  descending 
colon  and  the  sigmoid  flexure,  are  all  supplied  by  the  inferior  mesenteric 
ganglion.  This  inferior  mesenteric  ganglion  is  found  on  the  inferior  mes- 
enteric artery,  and  you  can  reach  it  by  working  a  little  toward  the  left 
about  two  inches  below  the  umbilicus.  We  have  very  good  results  in  cases 
of  constipation  by  working  there  and  stimulating  that  plexus ;  the  inferior 
mesenteric  ganglion  of  the  sympathetic. 

In  speaking  of  the  use  of  bile  it  is  not  only  helpful  in  cases  of  diar- 
rhea, flux  and  constipation,  but  that  is  our  way  of  destroying  entozoa,  tape 
worms,  or  seat  worms,  or  parasites  of  any  kind.  It  is  said  it  is  always 
beneficial  to  stimulate  the  flow  of  bile  in  such  cases,  and  very  frequently 
that  is  all  that  is  necessary,  thus  causing  the  worm  or  parasite  to  be 
acted  upon  by  the  bile.  In  treatment  of  constipation  you  will  frequently 
find  that  the  patient  is  in  trouble  because  he  has  not  drank  enough  water, 
and  that  is  why  very  frequently  it  is  necessary  to  prescribe  so  many  glasses 
of  water  in  a  day,  you  can  say  mineral  water  or  spring  water,  or  some- 
thing of  that  kind,  so  they  will  think  you  are  particular  about  it.  It  is 
said  that  the  explanation  of  why  drinking  of  water  is  beneficial  in  cases 
of  constipation,  is  that  when  the  stomach  is  empty  (the  water  should  be 
used  one  half  hour  before  breakfast)  that  the  water  passes  into  the  in- 
testine, is  easily  absorbed  by  the  lacteals  and  carried  to  the  portal  cir- 
culation. That  stimulates  the  flow  of  bile,  and  increases  its  quantity,  and 
thus  it  affects  the  fecal  contents. 

As  to  the  treatment  of  the  SPLEEN,  I  have  already  shown  you  that. 
You  will  find  that  there  is  a  tenderness  along  the  spine  behind,  and  in  front 
along  the  region  of  the  ninth,  tenth  and  eleventh  ribs  on  the  left  side  in 
such  cases,  and  Dr.  Harry  Still  tells  me  that  in  such  cases  it  has  been 
his  experience  to  find  a  cold,  clammy  perspiration,  especially  on  the  left 
side  of  the  body.  What  we  do  there  I  have  explained,  raise  the  ninth, 
tenth  and  eleventh  ribs,  and  work  carefully  under  the  tips  of  the  lowest 
ribs  in  front.  As  I  explained  at  the  last  lecture,  the  vaso-motor  supply  of 
the  spleen  is  not  understood,  but  it  was  stated  that  we  changed  its  size 
by  work  upon  the  peripheral  terminals  of  the  splanchnics.  It  is  understood 
also  that  there  is  a  center  in  the  medulla.  There  is  also  a  center  in  the 
medulla  for  the  intestines,  and  it  seems  that  some  trouble  with  the  atlas, 
or  some  tightening  of  the  ligaments  may  impinge  upon  the  sympathetics 
and  thus  get  an  effect  either  through  the  medulla  or  directly  through  the 
sympathetic  system. 


TREATMENT  OF  THE  KIDNEYS.  187 

LECTURE  XXVI. 

At  the  last  lecture  I  was  following  the  subject  of  examination  and 
treatment  of  the  abdominal  contents.  I  shall  pursue  that  subject  further 
to-day,  taking  up  also  the  pelvis,  its  examination  and  treatment,  particu- 
larly with  regard  to  slips  or  twists  of  the  pelvis  as  a  whole  and  of  the 
innominate  bones.  We  had  gotten  as  far  as  to  the  KIDNEYS.  To  treat  the 
subject  in  a  general  way  we  can  only  say  that  where  there  is  trouble  with 
the  kidneys  there  is  a  tenderness  in  the  back;  frequently  contractures  or 
displacements  along  the  spine.  There  are  general  symptoms  which  you 
will  learn  to  recognize,  and  which  you  will  find  by  urinalysis,  which  you 
have  learned  elsewhere.  Also  such  things  as  odor  of  the  breath,  and  con- 
dition of  the  tongue;  it  is  said  that  a  furrowed  or  ridged  tongue  indicates 
kidney  disease.  The  complexion,  and  various  things,  are  indications  of 
kidney  disease;  also  fever,  as  in  suppression  of  the  urine,  since 
then  the  system  is  poisoned.  Often  you  have  painful  micturition 
due  to  bladder  or  kidney  disease,  and  so  on.  The  chief  thing,  however, 
is  how  we,  as  Osteopaths,  treat  the  kidney.  The  nerve  supply  is  largely 
through  the  renal  splanchnics,  the  last  splanchnic  rising  opposite  the  twelfth 
dorsal.  I  have  shown  you  how  we  should  work  there.  Also  the  second 
lumbar  is  the  center  for  micturition,  and  the  effect  that  we  get  by  working 
upon  the  second  lumbar  is  probably  a  vaso-motor  effect,  since  you  know 
that  vaso-motors  leave  the  spine  all  the  way  down,  especially  from  the 
sixth  dorsal  to  the  second  lumbar,  having  both  vaso-dilators  and  vaso- 
constrictors within  those  limits.  A  lesion  at  the  atlas  also  affects  the 
kidneys,  probably  by  an  affect  upon  the  renal  center  in  the  medulla. 
Hence,  we  always  examine  to  find  whether  or  not  the  atlas  is  displaced, 
and  if  not,  we  are  able  to  get  an  effect  upon  the  renal  center  in  the  medulla 
by  working  on  the  superior  ganglion,  and  in  the- sub-occipital  fossa.  Hence, 
we  get  a  sympathetic  effect.  Now,  a  lesion  in  the  cervical  region,  especially 
at  the  upper  part,  at  the  atlas,  may  affect  the  kidney  directly  through 
the  sympathetics,  and  indirectly  through  the  center  in  the  medulla. 

One  of  the  best  ways  to  treat  the  kidneys  is  the  method  employed  by 
Dr.  Harry  Still ;  have  the  patient  upon  the  back,  with  the  knees  flexed ; 
you  then  have  all  the  muscles  relaxed.  Then  by  lifting  along  in  the  region 
of  the  lower  splanchnics,  simply  raising  the  patient  upon  the  fingers  and 
springing  outward  as  you  go,  you  relax  the  contractions,  spring  the  liga- 
ments, and  get  a  general  stimulating  effect  upon  the  kidneys.  You  will 
find  that,  I  think,  one  of  the  best  treatments.  Another  treatment  is  'to  press 
at  the  umbilicus,  and  by  pressing  deeply,  spreading  and  stimulating 
probably  the  sympathetic  ganglia  upon  the  renal  vessel,  as  there  the  renal 
ganglia  occur.  Also  the  centers  which  I  have  before  mentioned,  occurring 
one  on  either  side  of  the  umbilicus  below  the  skin,  called  perintoneal  cen- 


188  TREATMENT   Of  THR   KIDNEYS.      PELVIS. 

ters,  have  an  effect  upon  the  kidneys,  and  I  do  not  doubt  that  we  get 
some  sort  of  a  mechanical  effect  also  in  this  way,  by  relieving 
any  pressure  which  may  be  upon  the  renal  vessels.  There  are  other 
things  that  may  bring  mechanical  pressure  upon  the  renal  vessels,  such 
as  aneurism  of  the  abdominal  aorta,  an  enlargement  of  some  one  of  the 
abdominal  organs,  or  tumors,  and  in  those  cases  you  must  direct  your 
treatment  to  the  conditions  which  are  producing  the  disease'. 

You  will  frequently  meet  cases  of  renal  colic,  that  is,  stone  in  the 
kidney  or  in  the  bladder,  and  in  the  passage  of  the  stone  down  the  ureter 
the  pain  is  excruciating.  Renal  colic  is  the  name  given  to  the  pain  caused 
by  the  passage  of  the  stone.  The  deposit  varies,  sometimes  the  stone  is 
large,  and  it  varies  in  composition.  I  do  not  need  to  go  into  that,  as  such 
is  not  the  purpose  of  this  lecture ;  sometimes  it  is  a  crystal  of  uric  acid 
about  which  deposits  aggregate.  As  to  the  proper  treatment  for  it,  when 
a  stone  is  started  from  the  pelvis  of  the  kidney  down  the  ureter,  it  is  our 
treatment  to  work  along  the  course  of  the  ureter  and  to  work  it  back,  if 
possible,  because  you  can  dissolve  it  as  well  in  the  kidney  as  you  can  if 
you  press  it  on  down  to  the  bladder.  If  it  has  started  on  down  the  ureter 
and  cannot  be  worked  back,  it  should  be  worked  on  down  into  the  bladder. 
You  know  what  the  course  of  the  ureter  is,  from  about  the  level  of  the 
umbilicus,  a  couple  of  inches  each  side,  down  obliquely  to  the  base  of 
the  bladder.  I  do  not  mean  to  say  that  you  can  feel  the  ureter  by  work- 
ing along  its  course.  You  can,  however,  bring  deep  pressure  along  its 
course,  and  thus  work  upon  any  stone  which  may  be  in  it.  That  is  fre- 
quently done.  In  such  cases  our  treatment  would  be  directed  to  stimulat- 
ing the  general  health  oi  the  kidneys,  that  is,  to  increase  its  healthy  action, 
so  that  these  stones  could  not  be  formed.  If  your  kidney  is  acting  prop- 
erly you  will  not  have  renal  calculus.  Not  only  would  we  take  care  of  the 
renal  splanchnics,  and  the  second  lumbar,  but  of  all  the  lumbar  and  lower 
dorsal  region.  I  have  tried  to  teach  you  that  your  lesion  may  be  at  the 
center,  but  it  may  be  above  or  below,  causing  trouble  with  the  kidneys. 
In  general  our  success  with  kidney  troubles  has  been  very  good.  When 
you  come  to  general  treatment,  drinking  of  hot  water,  bathing,  and  ex- 
ercises are  all  good.  There  are  some  who  believe  that  it  is  beneficial  to, 
as  they  call  it,  flush  the  kidney  every  morning,  by  taking  a  drink  of  water 
before  breakfast.  That  acts  upon  the  kidneys  as  well  as  the  bowel.  It  is 
probable  that  the  increased  excretion  would  tend  to  keep  the  kidneys 
flushed.  Byron  Robinson  notes  that  fact,  but  does  not  give  it  the  weight 
of  his  authority. 

As  to  examination  and  treatment  of  the  PELVIS,  that  is  an  important 
thing  in  our  work.  The  pelvis  or  the  innominate  bone  may  be  slipped 
in  different  directions,  and  the  correction  of  these  slips  gives  the  Osteo- 
path very  gratifying  results  indeed.  The  whole  pelvis  may  be  slipped 


TREATMENT   OF   THE    PELVIS.  189 

forward  or  it  may  be  tipped  backward,  or  the  whole  pelvis  may  be  twisted 
to  one  side,  and  you  would  have  tenderness  on  each  side  at  the  sacro-iliac 
synchondrosis  particularly.  You  will  also  have  tenderness  at  the  symphy- 
sis,  for  the  reason  that  the  sacrum  is  broader  in  front  than  behind, 
and  movement  of  the  parts  would  tend  to  cause  the  wedge-shaped 
sacrum  to  act  upon  the  innominate  bones  and  to  press  them  apart,  thus 
you  would  have  a  strain  at  the  symphysis,  and  you  would  also  have  tender- 
ness here.  In  examining  for  these  troubles,  always  pay  attention  to  the 
symphysis.  You  would  always  have  tenderness  where  the  ligaments  bind 
the  back  part  of  the  sacrum  to  the  innominate  bones.  If  the  pelvis  is  tilted 
backward,  your  hand,  when  it  has  become  able  by  touch  to  detect  the 
departure  from  the  normal,  will  find  that  the  posterior  portions  of  the 
crests  of  the  ilia  are  projecting  farther  back,  and  when  tilted  forward, 
that  the  posterior  portions  of  the  crests  are  tilted  farther  forward,  so  that 
you  will  find  out  whether  the  position  is  correct  when  you  examine  by 
palpation,  which  is.  our  general  method.  Now,  if  the  pelvis  is  twisted  from 
side  to  side,  you  would  find  a  tenderness  on  each  side  at  the  sacro- 
iliac  articulation,  as  well  as  a  tenderness  in  front  at  the  symphysis,  and 
you  will  have  to  judge  which  is  the  case.  If  the  pelvis  is  twisted  you 
can,  by  examining  the  back,  get  an  indication  of  which  way  it  is  twisted. 
It  will  take  very  close  work  in  examination,  and  you  have  to  give  it  your 
careful  attention.  The  reason  why  you  would  have  tenderness  on  each 
side  is  that  in  a  twist  of  the  pelvis  from  side  to  side  you  would  have  both 
ligaments  thrown  on  a  strain,  one  diagonally  backward,  and  one  diagonally 
forward,  and  you  would  get  tenderness  in  each  case.  When  you  have 
these  slips  and  twists,  you  have  something  then  that  is  affecting  the  sacral 
plexus  of  nerves,  and  the  result  may  be  pain  down  the  legs,  or  you  may 
have  sciatica  in  one  or  both  limbs.  The  most  fruitful  source  of  pelvic  dis- 
orders, especially  of  female  troubles,  is  a  slip  of  the  innominate,  as  you 
will  see  later.  So  your  examination  would  include  both  the  symphysis  in 
front,  and  the  articulations  behind,  coupled  with  an  examination  for  gen- 
eral disorders  of  the  pelvis,  and  even  down  into  the  limbs. 

Now,  as  to  how  to  treat  the  pelvis  if  it  is  tilted  forward.  One  of 
the  best  ways  is  to  set  the  patient  on  a  chair,  and  then  by  putting  the 
knee  in  the  sacrum  behind,  we  can  reach  in  front,  get  hold  of  the  an- 
terior superior  spines,  and  pull  backward :  it  does  not  take  a  great 
deal  of  force,  and  at  the  time  it  is  quite  a  good  movement  to  pull  the 
patient  forward.  If  the  pelvis  is  twisted,  then  the  lower  part  of  the 
body  in  respect  to  the  waist  is  turned  to  one  side  or  the  other.  One 
of  the  best  ways  to  fix  that  is  to  set  the  patient  on  a  chair  and  place  his 
arms  up  over  your  shoulder,  then  twist  to  one  side  or  the  other,  making 
an  effort  to  move  the  whole  trunk  of  the  body  upon  the  articulation 
with  the  pelvis,  and  that  is  rather  a  movable  point,  and  often  the 


190  TO   SET  THE   INNOMINATE. 

point  of  displacement,  you  can  readily  turn  it  from  side  to  side.  You 
can  also  move  the  whole  pelvis  forward  by  some  such  motion  as  this: 
have  the  patient  lying  upon  his  side,  you,  standing  behind,  can  make 
a  fixed  point  with  one  hand  against  the  back  of  the  sacrum,  and  can 
pull  the  limbs  backward;  that  v/ould  be  when  the  pelvis  was  tilted 
backward.  Or,  you  can  place  your  knee  against  the  back,  and  pull 
back  on  one  side  and  then  on  the  'other  with  the  patient  lying  upon  his 
side  on  the  table,  or  sitting  in  the  chair.  Some  will  prefer  that  method 
perhaps.  One  of  the  best  ways  to  move  the  pelvis,  with  the  patient  on 
his  back,  is  to  bend  your  hand,  place  it  under  the  sacro-iliac  articula- 
tion, and  then  flex  the  thigh,  and  pull  the  knee  down,  out  and  around 
quite  strongly,  thus  relaxing  the  ligaments  of  the  articulation.  That 
should  be  done  upon  one  side  and  then  upon  the  other.  Our  experi- 
ence and  practice  has  taught  us  this  one  thing:  that  ligaments  are  ex- 
tremely important.  You  may  have  a  cold,  and  the  effect  upon  the  liga- 
ments will  be  to  contract  them,  and  you  will  have  luxations  of  the  parts 
affected,  from  that  simple  fact.  You  may  have  dislocations  of  the  pelvis 
or  of  one  of  the  innominate  bones. 

I  had  quite  a  remarkable  case  the  other  day — there  was  almost  com- 
plete paralysis  of  the  lower  limbs.  The  patient  went  about  in  a  chair. 
That  had  all  been  brought  on  by  la  grippe,  and  the  whole  body  had 
ceased  to  grow,  the  arms  were  thin  and  small,  the  face  and  head  were 
normal,  and  you  got  the  impression  of  looking  at  a  dwarf.  So  it  is  thai 
a  cold,  light  or  severe,  may  act  upon  the  ligaments  and  contract  them 
and  'thus  cause  a  luxation  of  the  parts,  and  there  is  no  doubt  that  is 
frequently  the  cause  of  displacement  of  the  pelvis  as  of  ether  parts. 

Now,  not  only  may  the  whole  pelvis  move  one  way  or  the  other, 
but  one  innominate  bone  may  move  one  way  or  the  other.  That  is, 
the  whole  bone  may  be  slipped  up  or  down,  or  it  may  be  tilted  backward 
or  forward.  However,  when  the  bone  is  tilted  forward,  you  will  see 
that  it  almost  inevitably  goes  somewhat  upward  on  account  of  the  shape 
of  the  articulation  with  the  sacrum.  From  that  fact,  since  when  it  is 
tilted  somewhat  forward,  and  at  the .  same  time  has  a  tendency  to  slip 
up  along  the  back  part  of  the  articulation,  it  will  have  the  effect  of  short- 
ening the  leg.  Consequently  when  the  innominate,  not  the  pelvis  as  a 
whole,  is  slipped  forward,  you  might  have  a  shortening  of  the  leg. 
Naturally  you  would  suppose  that  a  slipping  forward  of  the  pelvis  would 
lengthen  the  leg,  but  you  can  see  from  what  I  have  said  that  such  is  not 
likely  to  be  the  fact.  That  would  change  the  normal  axis  of  the  parts. 
The  various  axes  are  made  by  junction  of  the  sacrum  and  ilum  by  means 
of  ligaments,  and  when  the  innominate  bone  is  moved  in  one  direction 
one  point  will  be  fixed  and  act  as  an  axis,  while  another  point  will  be 
fixed  and  act  as  an  axis  in  another  position  of  the  innominate  bone. 


TO    SET   THE    INNOMINATE.  191 

That  subject  has  not  been  thoroughly  studied  our,  but  it  is  a  fact  that 
when  the  innominate  is  slipped  forward  then  you  have  a  shortened  leg, 
and  when  backward  you  will  probably  have  a  lengthened  leg.  Dr.  Harry 
Still  is  authority  for  the  statement  that  a  twisted  or  tilted  innominate 
may  shorten  a  leg  as  much  as  three  inches.  A  novice  looking  at  such 
a  condition  would  think  at  once  that  the  hip  was  dislocated,  but  it  is 
not  always  the  case,  and  you  must  be  careful  in  your  examination.  One 
of  the  first  things  in  examination  is  to  make  these  motions  of  the  thigh, 
flexion,  extension,  adduction,  abduction,  and  circumduction,  for  the  pur- 
pose of  relaxing  all  unnatural  tension  about  the  leg,  so  that  you  can 
tell  whether  or  not  the  limbs  are  similar.  Then,  placing  the  patient 
straight  upon  the  table,  which  you  will  have  to  by  accuracy  of  your 
eye,  you  can  judge  whether  or  not  a  line  drawn  between  the  anterior 
superior  spines  of  the  ilia  is  at  right  angles  to  the  direction  of  the  body. 
Then  you  will,  by  taking  a  certain  point,  preferably  the  bottom  of  the 
heels,  or  just  where  the  seam  runs  around  above  the  heel  of  the  shoe. 
note  whether  the  limbs  are  of  the  same  length.  You  will  have  to 
notice  any  variation  in  the  thickness  of  the  heel ;  some  peo- 
ple have  a  thickened  heel  or  sole  put  on  their  shoes  for  the  very  reason 
that  their  limb  is  a  little  shorter,  though  quite  as  frequently  the  condi- 
tion has  not  been  discovered.  When  you  have  pain  in  the  lumbar  region 
of  the  back,  pain  in  the  hip,  or  in  the  leg,  or  in  the  sacral  region,  or  in 
the  external  genitals,  you  will  do  well  to  examine  to  see  if  the  limbs  are 
of  the  same  length,  and  if  such  is  not  the  case  you  may  continue  the 
examination  further  by  looking  to  see  whether  or  not  the  pelvis  or  one 
of  the  innominates  is  displaced. 

When  measuring  one  leg  by  the  other  you  have  a  variable  standard, 
it  is  hard  to  tell  whether  or  not  one  leg  is  longer  than  it  ought  to  be, 
or  shorter.  So  you  have  to  take  means  of  determining  which  is  the 
affected  side.  It  is  well  to  go  to  the  sacral  articulations,  where  there 
will  be  soreness  on  the  side  affected,  because  a  greater  strain  has  come 
upon  the  ligaments  there,  and  you  will  also  have  a  soreness  on  the  sym- 
physis  pubes.  You  will  frequently  have  a  tension  and  some  tender- 
ness from  contraction  of  the  muscles,  on  the  opposite  side  from  the 
one  affected.  Taking  this  left  one  as  the  one  affected,  then  you  might 
have  a  contracture  and  some  tenderness  on  the  right  side,  because 
when  you  have  one  thrown  out  of  position,  then  you  have  the  equilib- 
rium destroyed.  There  has  to  be  accommodation  of  the  parts,  and 
there  will  be  tension  there  on  that  account,  but  I  think  the  rule  given 
you  will  indicate  to  you  which  is  the  side  affected. 

As  to  how  we  may  remedy  the  defect  of  one  innominate  being 
slipped,  there  are  various  ways;  some  are  the  same  as  I  have  shown 
you.  As  I  have  said,  the  motion  employed,  by  flexing  the  thigh 


192  TO    SET  THE    INNOMINATE. 

against  the  thorax,  placing  the  hand  firmly  under  the  pelvis,  and  push- 
ing the  knee  outward  and  down,  thus  straightening  the  leg  again,  is  one 
of  the  best  methods.  After  you  have  done  that,  it  is  well  to  give  the  leg 
a  straight  pull,  not  a  jerk.  You  thus  bring  tension  upon  the  liga- 
ments, and  in  that  way  frequently  straighten  mechanically,  and  I  think 
you  get  a  certain  nervous  effect  that  will  relax  the  spasm.  It  is  like  put- 
ting your  hand  upon  a  contracture  and  gently  pulling  against  the  con- 
tracture  until  you  have  relaxed  it,  so  it  is  with  the  limb,  you  can  relax 
•the  spasm  of  the  muscles,  you  can  restore  the  equilibrium  of  nerve 
force,  and  it  will  return  to  normal.  That  is  one  way;  another  is  for  the 
operator  to  stand  in  front  with  the  patient  upon  his  side,  then,  by 
reaching  under  the  upper  limb  and  grasping  the  tuberosity  below,"  while 
the  other  hand  grasps  the  anterior  superior  spine  above,  you  can  move 
it  in  either  way  very  readily;  you  can  slip  the  innominate  forward  or 
backward.  That  is  one  of  the  best  ways.  You  can  in  that  way  stand 
in  front  of  your  patient  and  do  your  work.  You  can  stand  behind  the 
patient,  use  the  knee  as  a  fixed  point  against  the  sacrum,  and  then, 
holding  against  the  anterior  superior  spine,  work  it  backward.  When 
you  stand  behind,  the  idea  is  that  you  can  work  to  draw  the  anterior 
spine  toward  you.  Also  you  can  stand  behind  the  patient,  one  arm 
beneath  the  thigh  of  the  patient,  making  a  fixed  point  of  your  other 
hand  against  the  sacrum,  then  bend  the  leg  back  until  you  have  it  drawn 
back  to  a  considerable  extent,  varying  the  degree  of  tension  according 
•to  the  patient.  That  is  one  very  good  way  to  force  the  bone  forward. 
Pressure  upon  the  sacrum  is  very  frequently  employed;  it  is  one  of  Dr. 
Hildreth's  very  common  treatments.  In  a  great  many  cases  of  treat- 
ment along  the  lower  part  of  the  spine  he  will  finish  by  putting  his 
knee  against  the  sacrum  and  bringing  it  inward  against  the  patient,  while 
he  draws  the  pelvis  of  the  patient  back  towards  him.  The  idea  being 
to  relax  the  ligaments  and  to  take  off  the  tension  which  is  thus  brought 
upon  the  branches  of  the  sacrai  plexus.  From  what  I  have  said  and 
from  combinations  that  your  own  ingenuity  will  suggest  to  you,  you 
can  remedy  the  defect  when  the  innominate  is  slipped  upward  or  down- 
ward. You  might  set  the  patient  upon  a  chair  and  lift  upward,  at  the 
same  time  having  an  assistant  push  downward  upon  the  crest  of  the 
innominate  affected.  One  point  that  you  might  notice  in  regard  to 
affecting  the  innominate  is  the  fact  that  the  quadratus  lumborum  has  a 
tendency  to  increase  the  lesion  by  its  contracture,  and  in  relaxing  the  ten- 
sion about  the  innominates  when  displaced,  you  would  do  well  to  stretch 
the  quadratus  lumborum.  That  I  have  shown  before ;  give  it  the  diagonal 
stretch  this  way  once  or  twice  and  once  or  twice  the  other  way :  you  can 
do  that  better  with  an  assistant,  because  you  can  get  a  better  tension. 
I  think  this  shows  the  value  of  steady,  firm  work  over  the  body.  The  idea 


TREATMENT  OF  THE  BLADDER.  193 

of  working  with  jerks  is  bad,  because  as  a  rule,  when  you  exert  traction 
or  pressure,  the  idea  is  that  you  are  relaxing,  it  is~in  the  nature  of  inhibi- 
tion of  nerve  force,  and  if  you  go  at  it  with  a  jerk,  you  are  not  only  liable 
to  stimulate  instead  of  inhibit,  but  to  thus  set  up  a  firmer  contraction, 
whereas  you  wish  to  relax. 

In  treating  the  pelvis,  I  have  noted  the  point  that  you  can  work  upon 
the  spine  of  the  ischium,  thus  impinging  directly  upon  the  pudic  nerve. 
I  have  indicated  how  you  should  find  that  point  by  a  line  drawn  from  the 
posterior  spine  of  the  ilium  to  the  outer  side  of  the  tuberosity,  the  junction 
of  the  lower  with  the  middle  third  of  the  line  will  be  the  point  where  you 
can  best  impinge  upon  the  pudic  nerve,  and  then  by  relaxing  the  glutei 
muscles  by  drawing  the  limb  backward  some,  you  can  get  deep  pressure 
'a-t  that  point,  and  thus  stimulate  or  bring  pressure  and  inhibition  upon 
the  nerve.  The  effect  of  that  is  to  work  upon  the  perineal  branches,  and 
through  them  to  cause  contraction  of  the  perineum  itself. 

As  to  the  BLADDER,  the  point  at  which  we  reach  the  hypogastric  plexus, 
supplying  the  fundus  of  the  bladder,  is  at  the  fifth  lumbar.  And  then 
along  the  sacra!  region  we  get  some  motor  fibres  to  the  bladder.  Alon& 
the  lumbar  region,  according  to  Quain,  we  get  motor  fibers,  particularly 
to  the  circular  muscle  fibers  of  the  bladder,  including  the  sphincter.  He 
says  there  are  probably  also,  to  aid  those  fibers,  inhibitors  to  the  longi- 
tudinal fibers.  Thus,  work  along  the  lumbar  region  would  affect  the 
bladder.  An  inhibitory  effect  would  be  to  relax  those  circular  fibers, 
and  a  stimulating  effect  would  be  to  contract  the  circular  fibers.  In 
the  sacral  region  the  Osteopath  takes  as  his  center,  the  third  and  fourth 
sacral,  and  he  works  there  to  relax  the  spincter  of  the  bladder.  It  is 
stated  by  Howell's  Text  Book  that  stimulation  in  that  region  causes 
contraction  of  the  circular  muscle  fibers.  It  has  been  our  practice  that 
by  inhibiting  in  that  region  we  got  the  effect  of  inhibiting  these  fibers 
and  relaxing  the  sphincter.  It  is  stated  by  Howell's  Text  Book  that 
in  the  sacral  region  and  in  the  lumbar  region  there  are  no  vaso-motor 
fibers  given  off  to  the  blood  vessels  of  the  bladder. 

As  to  how  to  examine  the  BLADDER,  you  know  where  the  bladder  is 
situated;  when  distended,  it  will  rise  above  the  pubes,  and  you  will 
likely  find  it  by  the  tumor,  and  on  percussion  you  will  get  the  flat 
sound  from  the  contained  fluid,  so  that  will  be  part  of  your  examina- 
tion. But  the  general  symptoms  which  you  will  get.  particularly  in 
symptomatology  and  in  urinalysis,  will  direct  you  in  your  examination 
of  the  bladder.  If  you  have  a  case  of  ammoniacal  urine  you  will  be  able 
to  recognize  the  crystals  under  the  glass,  and  to  tell  whether  there  is 
trouble  with  the  bladder.  You  will  note  the  presence  of  bacteria,  set- 
ting up  a  decomposition  in  the  urine.  Several  months  ago  I  examined 
a  sample  of  urine  under  the  glass;  it  was  freshly  drawn  and  was  crowded 


194  TREATMENT   OF   THE    BLADDER. 

with  bacteria.  I  directed  the  operator  who  brought  the  sample  to  boil 
the  bottle  and  let  it  cool  and  thus  have  is  completely  sterilized,  and  bring 
me  a  sample  as  fresh  as  possible.  He  did  so,  and  examination  showed 
a  great  number  of  bacteria,  and  that  very  soon  after  obtaining  the  urine. 
This  indicated  the  presence  of  bacteria  in  the  bladder,  setting  up  a  de- 
composition of  the  urine.  In  that  instance  it  was  a  case  of  bladder  in- 
stead of  kidney  trouble,  as  had  been  thought.  That  case  had  an  enlarged 
prostate;  the  prostate  had  acted  as  a  partial  stricture  to  the  passage  of 
urine,  and  the  patient  had  used  a  catheter,  had  not  taken  any  precaution 
to  keep  it  antiseptic,  and  had  thus  brought  about  much  of  his  trouble. 
The  operator  washed  out  the  bladder  with  some  antiseptic  solution  and 
reduced  the  prostate,  and  the  patient  was  out  in  a  few  days.  He  had  been 
pronounced  ready  to  die  of  kidney  trouble,  but  the  trouble  was  all  in 
the  bladder  and  prostate.  In  all  our  treatments  we  get  particularly  an 
effect  upon  the  centers  indicated  in  the  spine,  viz.,  the  fifth  lumbar  and 
the  second  lumbar,  the  centers  respectively  for  the  hypogastric  plexus 
and  micturition.  The  treatment  there  is  the  same  as  I  have  shown  you 
in  how  to  treat  the  spine.  There  is  another  treatment,  though,  which 
I  have  also  shown  you.  the  treatment  by  raising  the  bladder  bodily. 
You  can  do  the'  same  thing  by  having  the  patient  stand  in  front  of  you, 
bending  forward  at  right  angle,  thus  letting  the  abdominal  contents  drop 
clown  toward  the  symphysis:  then  by  deep  pressure  of  your  hands  inward 
and  raising  as  the  patient  straightens  up,  you  can  raise  all  those  parts. 
I  have  spoken  of  enteroptosis.  the  dropping  down  of  the  intestine;  I 
shall  speak  presently  of  the  prolapsus  of  the  uterus,  and  all  those  things 
that  allow  a  legthening  and  a  relaxation  of  the  ligaments  which  bind 
these  abdominal  contents  to  the  walls. 

Anything  which  allows  a  relaxation  brings  down  those  strictures, 
and  the  Osteopath  argues  that  there  is  too  little  life  there.  Now,  how 
does  he  replace  those  things?  Should  he  simply  push  them  into  place, 
they  would  not  stay — they  must  be  held  there.  Hence,  the  importance 
of  our  work  along  the  spine,  stimulating  the  nerve  force  and  life  to  the 
omenta,  which  should  hold  these  abdominal  contents  in  place,  so  as  to 
regain  their  tonicity.  Never  forget  that  it  will  not  do  to  replace  a  pro- 
lapsed uterus  or  replace  intestines  which  are  displaced  by  reason  of 
enteroptosis.  unless  at  the  same  time  you  include  the  work  along  the 
spine;  that  we  work  with  the  idea  of  stimulating  the  life  of  the  liga- 
ments and  making  them  tense  again.  In  fact,  we  should  always  have 
that  in  view,  particularly  we  should  be  careful  to  stimulate  or  inhibit 
the  nerve  force  to  the  part  in  trouble. 

We  would  also  work  deeply  over  the  internal  iliacs.  That  is  one 
of  the  treatments  for  the  bladdfer  also.  We  thus  stimulate  the  blood 
supply  and  direct  it  more  particularly  to  the  part  affected,  by  reason 


TREATMENT   OP   THE   OVARIES.  195 

of  the  tendency  toward  the  normal.  That  treatment  is  very  effective  in 
such  troubles.  In  retention  of  urine  you  will  always  suspect  some 
stricture.  You  may  have  an  enlargement  of  the  prostate  or  some  trouble 
with  the  sphincter  of  the  bladder.  You  will  find  also  that  the  quantity 
of  urine  varies — after  long  reading  by  a  person  who  is  not  used  to  read- 
ing much,  the  amount  of  urine  may  be  increased,  and  after  hysteria  and 
various  troubles,  the  amount  of  urine  is  greatly  increased.  There  is  a 
motion  for  raising  'both  the  bladder  and  the  uterus.  Have  the  patient 
flex  the  thighs,  then,  directing  him  to  hold  the  knees  together,  you  push 
them  apart.  In  other  words,  you  work  against  the  resistance  of  the 
flexed  thighs.  In  that  way  the  psoas  muscles  will  contract,  and  the  idea 
is  that  as  you  push  the  £nees  out  the  bladder  will  be  raised ;  having  done 
that,  you  try  just  the  opposite,  tell  the  patient  to  hold  the  knees  apart  and 
you  draw  them  together.  'Mrs.  Patterson  employs  that  method  of  treat- 
ment very  frequently  and  has  had  very  good  success  in  female  troubles 
in  that  way.  It  affects  both  the  bladder  and  uterus. 

We  should  next  direct  our  attention  to  the  OVARIES.  They  are  found 
an  inch  and  a  half  inward)  from  the  anterior  superior  spines  of  the  ilia. 
It  is  said  that  one  cannot  find  them  by  feeling  over  the  abdomen  where 
they  should  be,  and  it  is  only  when  tender  or  when  enlarged  that  you 
will  be  able  to  make  out  by  physical  examination  the  location  of  the 
ovaries.  However,  when  inflamed,  as  they  very  frequently  are,  the  in- 
tense tenderness  there  about  an  inch  and  a  half  interior  to  the  anterior 
superior  spine  would  indicate  their  site.  Also  when  inflamed  they  fre- 
quently cause  a  swelling,  and  you  will  be  able  to  find  their  location. 
The  ovary  is  frequently  the  seat  of  tumor,  which  may  become  very  large, 
and  then  not  only  palpation,  but  inspection,  will  reveal  the  scat  of  the 
trouble.  Our  treatment  for  the  ovaries  is  through  the  lumbar  region. 
The  centers  given  t>y  Howell's  Text  Book  for  the  internal  genitals  are 
along  the  lumbar  region  from  the  second  to  the  fifth;  that  is,  vaso- 
motor  fibers  of  both  kinds  run  to  the  internal  genital  organs.  We 
should!  also  examine  carefully  the  sacro-iliac. region  and  the  lower  dorsal. 
The  center  for  the  blood  supply  for  the  ovary  is  between  the  tenth  and 
eleventh  dorsal,  and  you  should  look  all  the  way  from  the  ninth  to  the 
twelfth  dorsal  particularly,  to  see  whether  there  is  a  lesion  affecting  the 
ovaries.  We  work  upon  the  eleventh  dorsal,  restoring  it  to  normal 
when  it  has  been  misplaced,  both  is  cases  of  profuse  menstruation  and 
in  scant  menstrual  flow.  That  seems  to  be  the  particular  center  since 
it  has  control  of  the  blood  supply  to  the  ovary.  Also,  the  spermatic 
artery  in  the  male,  becoming  the  ovarian  in  the  female,  arises  about 
opposite  the  second  lumbar  vertebra,  that  is,  a  little  above  the  umbili- 
cus, and  by  working  in  deeply,  trying  to  get  as  far  as  possible  under  the 
transverse  colon,  and  working  on  down  in  the  direction  of  that  artery, 


193  EXAMINATION    AND   TREATMENT   OP   PELVIC    VISCERA. 

as  far  as  the  ovary,  you  will  be  able  to  stimulate  the  blood-flow,  while 
by  working  in  the  reverse  direction  you  stimulate  the  venous  flow.  Also 
work  over  the  uterine  blood  supply,  because  these  vessels  anastomose  a 
good  deal,  and  you  thus  stimulate  the  entire  blood  supply.  The  ovaries 
are  closely  concerned  with  menstruation,  and  it  will  be  worth  your 
while  to  bear  in  mind  that  they  act  alternately,  one  will  ovulate  one 
month  and  not  again  until  the  second  month.  So  if  you  have  trouble 
recurring  every  second  month,  you  will  be  able  to  calculate  that  the 
trouble  is  in  one  ovary  or  the  other,  and  your  further  examination  will 
indicate  to  you  which  is  the  ovarj'  affected. 

In  cases  of  obesity  where  the  patient  is  extremely  large,  cases  are 
on  record  where  the  accumulation  of  fat  has  acted  to  crowd  the  ovary, 
hence  the  menstrual  flow  did  not  occur  and  the  ovaries  were  atrophied. 
It  may  act  in  a  mechanical  way  and  separate  the  Fallopian  tube  from  the 
ovary  so  that  the  Fallopian  tube  cannot  take  up  the  ovum  when  dis- 
charged. If  you  have  a  case  of  menstrual  trouble  where  the  person  is 
extremely  obese,  you  will  bear  in  mind  that  the  obese  condition  itself 
may  have  some  effect  in  causing  the  trouble.  The  ovary,  as  it  is  situ- 
ated in  the  broad  ligament,  is  drawn  down  in  any  prolapsus  of  the  uterus 
and  will  be  implicated  in  many  troubles  of  that  kind.  As  for  treatment, 
it  is  especially  along  the  lumbar  region  and  also  at  the  centers  designated ; 
the  eleventh  dorsal,  not  forgetting  the  fifth  lumbar,  which  is  the  center 
for  the  hypogastric  plexus,  through  which  we  get  the  pelvic  plexuses 
which  have  to  do  with  the  life  of  the  ovary. 

Q.  In  the  case  of  paralysis  you  spoke  of,  caused  by  the  grippe, 
what  was  affected? 

A.  The  whole  spinal  life  was  affected.  I  have  seen  cases  where  the 
grippe  was  the  only  cause  apparently  and  the  whole  muscular  life  along 
the  spine  was  diminished. 

Q.     Do  you  think  that  can  be  corrected  by  treatment? 

A.     Yes,  sir;  I  think  we  can  secure  good  results. 

Q.     Does  that  include  the  ligaments  along  the  spine? 

A.  Yes,  sir;  that  is  the  main  trouble.  The  ligaments  are  contracted, 
shutting  off  the  nerve  force. 


LECTURE  XXVII. 

At  the  'last  lecture  I  spoke  of  the  examination  and  treatment  of  the 
pelvic  viscera.  I  shall  continue  that  subject  to-day,  concluding  the  ex- 
amination and  treatment  of  the  pelvis  and  its  contents,  and  taking  up 
the  Osteopathic  treatment  of  the  limbs;  I  shall  then  have  gone  over  the 
whole  body. 


EXAMINATION    AND  TREATMENT   OF   THB   PELVIC   VISCERA.  197 

I.  EXAMINATION  AND  TREATMENT  OF  THE  PELVIC 
VISCERA. — (Continued.) — The  next  organ  for  us  to  consider  is  the 
UTERUS.  I  might  say  in  passing  that  female  diseases  are  among  the  most 
numerous  cases  that  we  treat,  and  are  among  those  best  handled  by  us. 
A  very  large  per  cent  of  your  cases  will  be  various  female  troubles,  and 
you  will  have  very  good  success  with  them.  The  examination  of  the 
ovaries  I  spoke  of  at  the  last  meeting.  Next  to  the  ovaries  the  uterus 
is  quite  as  frequently  the  seat  of  tumors.  These  may  occur  in  any  part 
of  the  organ,  and  when  these  have  enlarged  the  organ  by  their  growth, 
you  can  by  the  ordinary  methods  of  examination  find  the  trouble.  In 
general,  speaking  of  troubles  of  the  uterus,  prolapsus  is  very  common, 
anteversion,  retroversion ;  also  anteflexion  or  retroflexion,  the  bending 
of  the  uterus  on  itself.  When  the  uterus  falls,  it  may  fall  forward  and 
impinge  upon  the  bladder,  and  thus  one  of  the  symptoms  will  be 
frequent  micturition.  It  may  fall  backward  and  impinge  upon  the  rectum, 
and  you  will  have  a  mechanical  cause  of  constipation;  dragging  pain  in 
the  loins  and  pain  down  the  limbs.  Frequently  it  is  associated  with 
local  headache,  which  is  generally  on  top  of  the  head;  it  may  be  on  the 
back  of  the  head  or  it  may  run  over  to  the  forehead  or  to  one  side,  but 
its  peculiarity  seems  to  be  that  it  becomes  a  local  headache.  There  are 
other  symptoms,  since  the  uterus  becoming  displaced  will  impinge 
upon  other  viscera  and  the  plexuses  of  those  viscera.  You  will  have 
sympathetic  troubles,  such  as  vomiting,  sick  stomach,  and  things  of  that 
kind.  In  case  of  any  displacement  of  the  uterus,  the  patient  is  likely  to 
be  very  sick  at  the  menstrual  period.  At  such  times  the  fact  that  the 
organ  is  down  and  is  thus  stopping  the  flow  of  the  blood,  will  lead  to 
this  condition.  I  have  seen  very  painful  cases  at  the  period  relieved  im- 
mediately by  replacing  the  uterus.  However,  that  is  not  usually  a  good 
plan  to  pursue  at  the  menstrual  period,  since  the  organ  then  is  very 
tender,  and  handling  is  liable  to  irritate  it  and  set  up  an  inflammation 
or  some  growth.  You  must  always  be  extremely  careful  in  local  treat- 
ments of  the  uterus. 

There  have  been  some  remarkable  cases  instanced  of  an  en- 
larged uterus.  The  uterus  normally  enlarges  within  physiologi- 
cal limits;  it  enlarges  also  from  tumor.  The  chief  way  in  which  tumor 
is  differentiated  from  the  normal  enlargement  of  pregnancy,  is  that  after 
a  certain  time  you  can  hear  the  uterine  souffle  and  the  foetal  heart  beat. 
Also  after  the  fourth  month,  sometimes  before  and  sometimes  later, 
you  will  get  the  movements  of  the  fetus.  Dr.  Smith  tells  quite  an  amus- 
ing story  of  a  lady  who  came  to  term,  she  was  perfectly  sure  that  she 
was  ready  to  be  delivered,  but  he  found  merely  gas  in  the  intestines, 
a  peculiar  movement  of  the  gas  had  simulated  the  movement  of  a  foetus, 
which  had  been  taken  for  quickening,  and  the  accumulation  of  gas  in 


198  TREATMENT  OF  THE  UTERUS. 

every  respect  simulated  pregnancy.  I  only  speak  upon  these  subjects  in 
a  general  way,  because  in  gynecology  and  obstetrics,  which  you  will  take 
up  later,  they  will  be  treated  fully.  What  I  aim  to  tell  you  is  how  the 
Osteopath  treats  the  uterus.  In  examining  the  uterus,  besides  these  gen- 
eral symptoms  I  have  given  you,  a  local  examination  will  usually  re- 
move all  doubt.  By  inserting  the  finger  into  the  vagina  you  can 'feel  at 
the  upper  end  of  the  vagina,  the  uterus.  You  know  how  the,  uterus  lies 
in  relation  to  the  passage  of  the  vagina — nearly  at  right  angles,  perhaps 
not  quite.  The  normal  feeling  of  the  cervix  is  described  by  Doctor  Still 
to  be  about  as  hard  as  the  end-  of  the  nose.  On  account  of  the  transverse 
direction  of  the  os  uteri  you  can  tell  whether  or  not  the  uterus  be  fallen 
or  twisted.  If  you  find  the  os,  instead  of  being  directed  from  side  to 
side,  is  turned  at  an  angle,  you  can  judge  from  that  in  which  direction 
the  uterus  has  been  turned.  The  most  common  displacement  is  said  to 
be  x  downward;  backward,  and  to  the  left.  Frequently  you  will  find 
a  turn  associated  with  this  displacement,  and  the  uterus  lies  down  near 
the  left  sacro-iliac  articulation.  If  the  uterus  has  fallen  forward,  you  will 
find  the  cervix  and  os  projecting  backward,  and  if  it  has  fallen  backward, 
you  will  have  the  cervix  and  os  projecting  forward.  So  you  will  be 
able  to  judge  as  to  its  position.  That  is  what  the  Osteopath  ascertains 
in  making  examination  per  vaginam — he  examines  to  see  whether  or 
not  the  uterus  is  in  normal  position. 

You  'know  about  the  eight  ligaments  of  the  uterus;  the  broad  liga- 
ments are  the  most  useful.  They  extend  from  each  side  to  be  attached 
to  the  pelvis,  and  when  the  uterus  is  displaced  to  one  side  you  will  find 
a  tenderness  in  the  broad  ligament  on  the  opposite  side,  readily  ex- 
plained as  the  tension  comes  upon  the  ligament  of  the  other  side,  the 
weight  coming  on  it  as  the  uterus  falls  from  it.  Another  point  in  exam- 
ination per  vaginam  is  to  note  the  condition  of  the  vaginal  walls.  In 
prolapsus  the  walls  have  lost  their  tone;  they  have  part  of  the  duty  of 
sustaining  the  weight  of  the  uterus.  When  they  are  full  of  tone  they 
will  help  to  hold  the  uterus  up,  but  if  they  are  prolapsed  and  sunken 
down  they  become  flaccid.  Frequently  you  can  give  .great  relief  in  fe- 
male troubles  by  simply  passing  the  finger  up  before  and  behind  and 
at  each  side,  smoothing  out  these  wrinkles  which  have  gotten  into  the 
walls  of  the  vagina.  You  can  also  by  that  treatment  stimulate  the  flow 
of  blood  and  the  local  nerve  force,  and  thus  lead  to  more  life  in  the 
vagina  and  consequently  to  a  better  performance  of  its  duty  of  helping 
to  hold  the  uterus  up. 

You  will  find  such  troubles  as  leucorrhea  following  the  displacement 
of  the  uterus,  since  the  nutrition  is  partly  cut  off  from  the  walls  of  the 
vagina,  the  circulation  is  impeded  and  the  healthy  tone  does  not  exist, 
consequently  you  have  a  morbid  secretion. 


TREATMENT   OF   THE    UTERUS.  199 

The  normal  position  of  the  uterus  I  suppose  is  known  to  you — the 
broad  ligament  tilts  somewhat  backward  in  the  pelvis  and  the  uterus  is 
tilted  forward  at  the  upper  end  of  the  vaginal  passage,  so  that  you  have 
practically  speaking  a  right  angle  between  the  canal  of  the  vagina  and 
the  uterus;  perhaps  not  quite  a  right  angle.  The  uterus  normally  does 
not  rise  above  the  brim  of  pelvis.  I  wish  to  emphasize  what  I  said  the 
other  day  in  regard  to  prolapsus  of  the  uterus  and  of  the  intestine,  that 
is,  the  Osteopath  replaces  them,  but  does  not  expect  them  to  stay 
simply  because  he  has  replaced  them.  You  must  always  couple  local 
treatment  with  treatment  along  the  spine.  I  remember  a  case  in  point 
— I  examined  a  young  lady  in  Peoria.  she  had  a  twist  in  the  gym- 
nasium, she  had  jumped  to  catch  a  cross-bar  and  had  given  herself  a 
jerk  and  a  twist.  Along  in  the  upper  lumbar  region  there  was  a  lesion,  T 
do  not  remember  now  exactly  which  vertebrae  were  displaced,  it  was, 
however,  one  of  the  lumbar  vertebrae,  there  was  quite  a  prominence  of  one 
ef  them.  Shortly  after  the  accident  the  young  lady  was  bothered  with 
frequent  micturition,  and  local  examination  later  revealed  the  fact  that 
the  uterus  was  down  upon  the  bladder.  That  case  was  treated  at  the 
abdomen,  over  the  iliacs,  and  along  the  spine,  particularly  at  the  second 
and  fifth  lumbar  centers,  through  which  you  can  reach  the  uterus.  The 
case  was  entirely  cured  within  two  months,  and  she  had  not  had  local 
treatment  more  than  a  half  dozen  times.  So  you  see  the  Osteopath 
does  not  depend  upon  simple  reposition,  he  depends  largely  upon  the 
work  of  stimulating  the  nerve  force  and  toning  up  the  blood  supply 
to  give  tone  to  these  ligaments  which  have  lost  their  strength,  and  thus 
hold  the  parts  in  place.  The  first  finger  is  usually  inserted,  and  you  can 
feel  the  cervix  of  the  uterus.  The  idea  then  is  to  push  upward  in  such 
a  way  that  the  organ  will  take  the  position  of  being  at  a  right  angle  to 
the  broad  ligament,  and  it  is  well,  while  your  patient  is  upon  the  table 
to  insert  the  finger,  reach  upward  to  the  uterus,  then  have  the  patient 
slip  around  and  stand  up  and  you  can  then  push  the  organ  up  into  place. 
One  of  the  best  ways  of  replacing  the  uterus  is  to  have  the  patient  take 
the  knee-chest  position — kneel  with  the  chest  down  upon  the  table  or 
bed.  and  then  to  push  the  uterus  up,  and  thus  allow  the  intestines  to 
fall  down  behind  and  over  the  uterus  and  hold  it  in  place.  Doctor  Still 
has  invented  an  instrument  which  is  very  useful  also  in  re-position. 
It  is  a  wire,  curved  with  a  handle.  The  finger  of  the  operator  is  slipped 
in  with  the  instrument,  lying  in  the  opening  between  the  two  wires,  and 
then  the  point  of  the  instrument  is  placed  either  behind  or  in  front  of 
the  cervix,  depending  upon  the  position  of  the  organ,  whether  it  has 
fallen  forward  or  backward.  Then  with  the  point  of  the  -  instrument 
back  and  the  finger  in  front,  or  vice  versa,  you  can  place  the  organ  as 
you  wish.  Also  you  can  by  working  upon  the  abdomen  aid  to  lift  the 


200  TREATMENT  OF  THE  UTERUS. 

parts.  I  have  already  shown  you  how  that  is  done.  That  is,  you  raise 
it  with  the  patient  upon  the  back  as  I  have  shown  you,  or  with  the  pa- 
tient upon  the  side,  or  standing  bent  at  a  right  angle,  and  you,  pushing 
the  fingers  in  deeply  over  the  abdomen,  raise  the  contents  bodily.  It 
is  also  a  good  idea  to  have  the  patient  practice  taking  the  knee  and 
chest  position  and  simply  dilating  the  passage,  the  atmospheric  pressure 
will  sometimes  be  sufficient  to  cause  the  uterus  to  take  its  place;  also 
the  motion  I  showed  you  at  the  last  meeting,  having  the  paptient  lie 
upon  the  back,  flex  the  thigh,  and  the  operator  draws  the  limbs  apart 
while  the  patient  is  holding  them  together,  and  draws  them  together 
while  they  are  held  apart  by  the  patient. 

Treat  especially  the  centers  mentioned,  that  is,  the  second  lumbar, 
which  is  the  blood  supply  for  the  uterus,  and  the  fifth,  which  is  the  center 
through  which  we  reach  the  hypogastric  plexus,  and  all  along  the  lumbar 
and  sacral  region  in  general,  but  do  not  fall  into  the  error  of  thinking  the 
trouble  is  always  there,  because  the  lesion  may  be  above  or  below  the  cen- 
ter at  which  you  naturally  expect  to  find  it. 

I  have  already  mentioned  the  point  that  you  should  stimulate  the  coccy- 
geus  muscle  through  the  sacral  plexus,  and  thus  cause  it  to  contract  and 
aid  in  raising  the  contents  of  the  pelvis.  You  can  also  stimulate  the  round 
ligaments  which  pass  over  the  pubic  arch  just  external  to  the  symphysis; 
you  can  find  them  both  by  the  touch  and  by  their  sensitiveness,  because 
when  you  impinge  upon  them  you  will  always  ha,ve  an  expression  of  pain. 
Stimulation  there  will  help  to  draw  up  the  uterus ;  all  these  things  help  a 
good  deal.  Stimulation  at  the  second  lumbar  is  used  to  cause  contraction 
of  the  longitudinal  fibres  of  the  uterus,  while  stimulation  of  the  clitoris 
and  round  ligaments  is  used  to  cause  contraction  of  the  circular  fibres 
of  the  uterus.  Consequently,  we  inhibit  over  the  clitoris  and  round  liga- 
ments to  cause  them  to  relax  and  thus  relax  the  circular  muscular  fibres 
of  the  uterus.  That  is  one  of  the  most  important  points  in  Osteopathic 
obstetrics. 

In  young  females  and  in  pregnant  women  it  is  advised  never  to  give 
an  internal  treatment.  It  has  been  found  that  remarkably  young  chil- 
dren are  sometimes  suffering  from  prolapsus,  and  mentions  a  case  in 
which  the  patient  was  not  over  two  years  old,  but  the  case  was  entirely 
cured  by  external  treatment.  Should  you  be  treating  a  case  for  other 
troubles  in  which  the  patient  is  pregnant,  carefully  avoid  the  ninth  and 
eleventh  dorsal  and  the  second  and  fifth  lumbar,  in  fact,  the  whole  lumbar 
region. 

Dr.  Bolles  has  mentioned  a  point  to  me  which  is  extremely  interesting, 
and  I  think  important  also.  In  a  case  in  which  there  had  been 
abortion  and  the  mother  had  kept  wasting  from  the  uterus,  a  discharge 
of  matter  and  flow  of  blood,  he  directed  her  to  rub  the  nipples  each  morn- 


EXAMINATION   AND   TREATMENT   PPR    RECTUM,  201 

ing  with  vaseline,  and  thus  to  simulate  as  far  as  possible  the  normal  irri- 
tation made  by  the  suckling  child.  She  was  thus  acting  in  accordance 
with  Nature,  and  the  discharge  ceased.  In  another  case  he  followed  the 
same  rule ;  the  pregnancy  was  about  three  months  along,  and  the  indica- 
tions were  that  the  foetus  had  been  dead  for  some  days.  The  nipples 
were  stimulated,  which  caused  contraction  of  the  uterus^  and  the  woman 
was  delivered  of  a  still-born  child.  There  is  a  very  close  connection  be- 
tween the  nerves  of  the  breast  and  of  the  uterus. 

It  is  a  very  good  point  in  flooding,  profuse  menstruation, 
or  in  flooding  after  child-birth,  or  in  post-partum  hemorrhage, 
which  is  a  very  serious  thing,  to  give  a  quick  jerk  at  the 
mons  veneris,  thus  causing  pain  and  contraction;  that  will  usu- 
ally stop  the  flooding.  I  knew  of  a  case  not  many  months  ago  in  which 
the  flooding  was  persistent,  and  lasted  for  some  time.  I  sent  word  to  the 
patient  to  try  the  treatment  I  have  described  and  the  flooding  ceased 
immediately.  Also  in  case  of  post-partum  hemorrhage  Doctor  Still  says 
you  should  insert  the  fingers  into  the  uterus  and  press  upward  against  the 
fundus.  He  presses  up  to  smooth  out  any  obstruction  which  may  cause 
the  trouble ;  there  is  some  obstruction  there  which  is  hindering  the  proper 
flow  of  the  blood  and  so  causing  the  hemorrhage,  and  simply  that  pressing 
up  allows  the  blood  vessels  to  resume  their  normal  relations  and  the 
hemorrhage  to  be  stopped.  You  understand  that  when  you  come  to  con- 
sider uterine  troubles,  it  is  a  subject  for  the  specialist,  and  you  will  hear 
this  subject  fully  treated  in  gynecology  and  obstetrics.  I  cannot  do  more 
than  simply  mention  to  you  the  usual  treatment ;  this  will  also  be  the  case 
later  in  this  lecture  when  I  will  take  up  the  subject  of  dislocations,  you  will 
get  them  more  fully  in  surgery,  but  I  will  give  you  the  usual  Osteopathic 
treatment  for  them. 

In  the  EXAMINATION  PER  RECTUM,  which  is  frequently  resorted  to  by 
the  Osteopath,  in  the  female  if  you  will  at  the  same  time  insert  a  catheter 
into  the  urethra  you  can  feel  the  urethra  along  the  anterior  wall  of  the 
vagina.  Here  is  an  important  point  which  I  have  never  heard  mentioned 
except  in  connection  with  Osteopathic  practice ;  if  the  vaginal  walls  are 
relaxed  and  have  fallen  in  response  to  a  prolapsed  uterus,  you  may  very 
likely  get  a  twist  or  an  obstruction  of  the  urethra  through  the  prolapsus 
of  the  vaginal  walls.  There  have  been  some  such  cases  here,  and  the 
trouble  has  been  readily  cured  by  smoothing  out  the  vaginal  walls  in  the 
manner  I  have  described,  and  by  passing  a  catheter  up  the  urethra, 
straightening  out  the  urethral  passage. 

You  find  in  digital  exploration  of  the  rectum  the  grip  of  the  external 
sphincter,  and  you  will  be  able  to  judge  whether  or  not  it  is  normal.  The 
normal  grasp  of  the  external  sphincter  is  extremely  powerful,  and 
in  all  these  internal  treatments  you  should  insert  the  finger  only  after  it 


202  TKKAi^tiw  ofi  ^WIBS  :    DISLOCATIONS. 

n /^03Y  cO          *~       ,M 

h^s  ,bceii  well  oiled  with"  Vaseline,  soapsuds,  or  something  of  that  kind. 
You  will  have  no  difficulty  in  inserting  the  finger  into  the  rectum ;  the 
palm  should  be  turned  toward  the  coccyx,  and  the  finger  inserted  and  then 
turned ;  the  patient  may  be  on  the  left  side,  or  may  be  stooping,  bent 
over  the  table.  You  will  also  in  your  practice  meet  cases  of  prolapsed 
rectum,  the  gut  may  be  prolapsed  and  be  folded  upon  itself  in  just  the 
way  the  vagina  prolapses.  In  Chicago  I  had  a  case  in  which  the  patient 
came  in  great  pain,  there  had  been  a  rectal  prolapsus,  and  there  was  great 
tenesmus — a  feeling  of  wanting  to  go  to  stool  continually.  It  was  extreme- 
ly painful  and  the  patient  was  able  to  walk  only  with  great  difficulty.  I 
surmised  at  once  that  there  was  a  prolapsus,  and  I  inserted  the  finger  and 
crowded  the  walls  of  the  rectum  upward  all  the  way  around.  I  was  able 
to  relieve  the  case  and  he  had  no  trouble  for  some  time  afterward.  In 
such  a  case  you  must  adopt  the  method  of  treating  over  the  spine  to 
stimulate  the  nerve  force  and  blood  supply  to  that  part,  and  thus  give 
permanent  relief. 

In  the  male  you  will  find,  after  inserting  the  finger  for  about  one 
inch  and  turning  it  forward,  the  prostate  gland.  It  is  said  by  some  author- 
ities that  the  prostate  gland  is  almost  universally  enlarged  in  men  over 
forty  years  of  age.  The  enlargement  of  the  prostate  is  frequently  the  cause 
of  stricture  of  the  urethra.  You  will  find  the  lateral  lobes  of  the  gland 
enlarged,  or  the  central  lobe  may  be  enlarged.  Should  the  lateral  lobes 
be  enlarged,  there  may  not  be  much  difficulty,  but  if  the  central  lobe  is 
enlarged  you  are  very  apt  to  have  stricture  of  the  urethra. 

All  of  these  internal  treatments  should  be  resorted  to  only  in  case  of 
necessity.  You  should  not  treat  internally  very  frequently;  not  more  than 
once  a  week,  and  sometimes  not  more  than  once  in  two  weeks  or  a  month. 
Be  very  careful  in  treating  internally,  as  you  may  irritate  the  internal 
parts.  When  the  prostate  is  enlarged  it  may  set  up  considerable  irritation, 
and  curing  that  may  be  the  only  way  of  curing  certain  genital  troubles  in 
the  male.  The  prostrate  is  often  easily  reduced ;  you  can  reduce  it  in  a 
half  dozen  treatments,  treating  once  a  week  or  once  in  two  weeks. 

Q.     Is  it  reduced  by  local  treatment? 

A.  By  local  treatments.  Of  course  you  must  couple  with  that  treat- 
ment over  the  internal  iliacs  to  tone  up  the  blood  supply. 

II.  OSTEOPATHIC  TREATMENT  OF  THE  LIMBS :— In  con- 
sideration of  the  ARM,  the  ball  and  socket  joint  at  the  shoulder  is  the  one 
most  likely  to  be  dislocated.  First,  I  will  describe  the  ways  in  which  this 
dislocation  may  occur.  The  dislocation  of  the  humerus  may  be  down- 
ward into  the  axilla,  it  may  be  backward  upon  the  back  of  the  scapula,  or 
in  front  under  the  clavicle,  or  it  may  be  slightly  upward,  against  the  cora- 
coid  process,  called  a  partial  dislocation.  The  treatment  for  any  of  these 
is  practically  the  same.  One  good  way  adopted  by  the  practice  is  to  put 


DISLOCATIONS,  203 

the  knee  under  the  axilla  firmly;  you  would  have  an  assistant  holding  the 
patient  to  exert  counter  pressure.  Then  press  the  arm  strongly  downward, 
and  thus  spread  the  joint,  bringing  tension  upon  the  contracted  muscles 
and  upon  the  ligaments,  and  they  will  draw  the  bone  down  into  place.  An- 
other way  is  when  the  patient  is  lying  upon  the  table,  to  place  the  stocking 
foot  in  the  axilla,  and  you  can  get  a  powerful  leverage  by  drawing  the  arm 
downward  from  the  shoulder,  and  can  force  the  bone  out  into  its  socket. 
This  is  a  frequent  dislocation  in  practice.  In  the  gymnasium  the  shoulder 
is  very  frequently  dislocated  and  set  by  a  move  on  the  rings,  without  harm. 
This  joint  is  usually  set  without  difficulty;  it  must  be  set  very  soon  after 
dislocation. 

In  dislocation  of  the  ELBOW,  there  are  five  different  displacements. 
Both  bones  may  be  dislocated  backward,  both  bones  may  be  dislocated 
internally  or  externally ;  the  ulna  may  be  dislocated  backward,  or  the 
radius  may  be  dislocated  forward  into  the  hollow  on  the  front  of  the 
humerus,  or  it  may  rarely  be  dislocated  backward.  One  method  is  to 
place  the  knee  in  the  bend  of  the  arm.  and  then  by  having  your  assistant 
exert  counter  traction  above  the  elbow,  you  can  spring  the  •arm  down 
strongly.  That  will  do  for  the  first  three.  When  you  have  thus  exerted 
considerable  tension,  enough  to  overcome  the  contraction  of  the  muscles, 
the  bones  will  slip  into  their  places.  When  the  radius  is  dislocated  for- 
ward, that  would  draw  the  hand  back,  and  by  turning  the  hand  toward 
the  supine  or  half  supine  and  exerting  traction  downward  and  outward 
in  such  a  way  as  to  pull  the  head  of  the  radius  down  towards  its  position, 
you  will  be  able  to  work  it  into  place. 

In  dislocations  of  the  WRIST,  both  bones  may  be  out  of  place ;  the  radius 
may  be  forward  or  the  ulna  backward,  and  in  all  those  cases  simple  ex- 
tension is  required ;  you  have  your  assistant  fix  the  elbow  while  you  exert 
powerful  traction  upon  the  parts  until  they  have  been  drawn  into  place. 

In  dislocation  of  the  FINGERS  it  is  said  dislocation  is  usually  between 
the  first  and  second  phalanges,  and  there,  also,  simple  extension  is  re- 
quired, drawing  straight  upon  the  finger  until  the  bone  is  slipped  back  into 
place. 

As  to  the  usual  way  of  treating  the  ARM,  you  have  seen  that  we  fre- 
quently use  it  as  a  lever.  In  some  cases,  as  for  instance  in  articular  rheu- 
matism, we  work  with  the  idea  of  spreading  the  joint  and  allowing  the 
blood  and  nerve  force  to  be  freed  about  the  joint,  especially  allowing  in- 
flow of  blood,  the  stimulation  of  the  blood  flow  thus  removing  the  deposit 
in  the  joint.  You  can  readily  stretch  the  joint  by  doubling  your  hand 
and  putting  it  under  the  axilla,  taking  care  not  to  present  the  knuckles 
toward  the  axillary  glands,  and  then  pressing  the  arm  in  against  the  side. 
That  will  draw  the  shoulder  down,  and  I  have  had  some  very  good  suc- 
cess in  relieving  cases  of  articular  rheumatism  in  that  way.  In  spreading 


204  TREATMENT   OF  THE   LOWER  LIMBS. 

the  joint  you  can  also  stimulate.  Place  your  hand  upon  the  front  of  the 
elbow  and  then  bend  the  forearm  strongly  over  your  hand ;  that  will  spring 
the  joint;  and  also  by  turning  it  out  at  a  right  angle  (you  know  how  the 
olecranon  process  articulates  at  the  back  of  the  humerus),  by  bending  the 
arm  at  a  right  angle  so  that  it  will  not  catch,  you  can  exert  pressure  to 
spread  the  joint.  Also  you  can  stimulate  the  flow  of  blood  down  the  arm 
by  a  certain  twisting  motion.  I  have  hold  of  the  arm  and  move  the 
head  of  the  humerus  in  the  socket.  I  twist  it  in  that  way  without  exerting 
much  force. 

I  might  speak  here  of  the  fact  that  you  can  impinge  upon  the  nerves 
of  the  inner  side  of  the  arm,  the  branches  of  the  brachial  plexus  run- 
ning down  there,  and  the  axillary  artery.  In  general,  if  you  impinge  upon 
an  artery,  press  it  toward  the  bone;  do  not  press  it  toward  the  muscle. 
You  will  find  in  your  practice  that  these  nerves  may  become  paralyzed  by 
the  use  of  a  crutch,  setting  up  crutch  paralysis,  and  that  is  a  point  which 
is  well  taken  into  consideration.  Also  we  have  found  in  our  practice 
that  something  will  catch  here  at  the  anterior  part  of  the  shoulder ;  whether 
it  is  deltoid  fibers  under  the  coracoid  process,  or  whether  it  is  a  simple 
binding  of  the  ligaments  drawing  the  head  of  the  humerus  out  against 
the  acromion  or  coracoid,  it  is  hard  to  say,  but  we  frequently  find  a 
catch  there  which  we  can  reduce  by  drawing  the  arm  upward  and  back- 
ward, and  then,  when  horizontal,  drawing  it  outward,  and  by  having 
the  fingers  in  front  over  the  process  one  can  free  any  obstruction  in  that 
way.  I  have  seen  cases  of  extremely  lame  arms  which  could 
not  be  raised  higher  than  the  head,  and  could  not  be  put 
behind  the  back,  relieved  by  that  treatment.  Sometimes  you  will 
have  such  an  injury  as  will  cause  a  contraction  of  one  of 
the  heads  of  the  biceps  muscle.  By  straightening  the  arm  and  draw- 
ing it  backward,  thus  lengthening  the  distance  between  the  attachments 
of  that  muscle,  you  bring  tension  upon  it.  Frequently  you  will  find 
that  muscle  contracted,  and  all  you  will  need  to  do  it  to  stretch  it,  thus 
inhibiting  its  nerve  force,  relaxing  its  spasm,  and  you  get  rid  of  the 
trouble. 

In  the  TREATMENT  OF  THE  LEGS  you  have  all  seen  the  various  motions 
we  perform;  perhaps  you  have  not  all  appreciated  what  the  purpose  of 
each  movement  was.  When  I  flex  the  thigh  above  "the  thorax,  and  the 
leg  upon  the  thigh  I  am  stretching  the  quadriceps  extensor  muscle. 
You  stretch  it,  and  with  it  you  free  the  blood  supply,  the  femoral  artery, 
the  anterior  veins,  and  the  anterior  crural  nerve.  That  is  the  purpose 
of  this  motion  which  you  see  so  frequently  employed.  Sometimes  we 
simply  use  this  motion  as  a  leverage,  having  our  hands  in  the  sacro- 
iliac  joints;  you  know  its  purpose  already.  You  have  thus  stretched  the 
anterior  muscles  of  the  thigh;  you  can  stretch  the  muscles  of  the  an- 


THE   LIMB  AND   FOOT.  205 

terior  part  of  the  leg  simply  by  pushing  the  toe  straight  down ;  hyper-ex- 
tension. That  is  a  most  frequent  motion  that  the  Osteopath  uses.  You  can 
stretch  the  calf  muscles  just  the  opposite  way,  by  pushing  the  toe  in  the 
direction  of  the  knee ;  and  you  will  have  no  difficulty  in  pushing  it  strongly 
enough.  We  can  stretch  the  adductor  muscles  by  holding  the  leg 
straight,  and  separating  the  legs.  You  can  stretch  the  external  rotators 
by  an  internal  rotation;  it  is  very  well  to  regulate  the  force  in  this  way; 
in  making  this  movement  turn  just  enough  so  that  the  patient  turns  on 
the  side,  it  is  not  necessary  to  use  a  great  deal  of  force;  then  turn  the 
other  way  until  you  have  turned  him  about  the  same  distance.  We  may 
also  stretch  the  muscles  on  the  back  of  the  thigh.  You  know  that  in 
raising  the  knee,  for  instance,  against  the  chest,  you  can  only  do  it  by 
bending  the  leg;  if  you  straighten  the  leg  you  can  get  it  to  a  certain 
height  and  then  you  feel  tension  upon  the  hamstring  muscles,  conse- 
quently we  frequently  use  that  in  our  practice.  Putting  the  heel  of  the 
patient  over  the  shoulder  of  the  operator  and  raising  the  limb  higher 
than  it  can  naturally  go,  you  thus  lengthen  the  distance  between  the 
points  of  attachment  of  the  muscles  on  the  iback  of  the  thigh  and  stretch 
them.  Frequently  you  will  find  it  important  to  stretch  those  muscles. 
I  had  a  case  the  other  day  of  this  kind,  where  the  legs  were  drawn 
with  rheumatism,  the  patient  had  no  use  of  the  limbs,  they  were  consid- 
erably drawn,  the  toes  were  turned  in,  the  muscles  were  set,  and  it  was 
with  difficulty  that  I  could  handle  them.  I  brought  deep  pressure  in 
Scarpa's  triangle  on  the  anterior  crural  nerves,  and  that  relaxed  the  an- 
terior muscles.  I  had  another  case  in  which  was  paralysis  of  the  lower 
limb,  and  frequently  the  limb  would  jerk  when  I  would  treat  it,  so  I 
inhibited  the  anterior  crural  nerve  and  the  limb  would  relax  directly. 
We  pay  particular  attention  to  Scarpa's  triangle  since  there  we  can  impinge 
upon  the  femoral  artery  and  vein,  and  upon  the  anterior  crural  nerve.  Also 
we  treat  in  the  popliteal  space;  we  very  frequently  knead  it  or  work  its 
contents,  simply  bending  the  knee,  putting  the  foot  of  the  patient  be- 
tween one's  knees  and  working  in  the  popliteal  space ;  one  can  thus  free 
any  contraction  there,  and  can  stimulate  both  the  popliteal  nerves  and  the 
blood  vessels. 

Frequently  in  cases  of  rheumatism  you  will  have  trouble  with  the 
feet.  You  can  straighten  them  down  forward  as  I  have  shown,  or  back- 
ward. In  treating  the  feet  you  will  see  that  there  are  two  natural  arches, 
one  lengthwise  of  the  foot,  and  one  crosswise  of  the  foot:  consequently 
in  your  treatment  of  the  feet  you  can  break  it  in  two  ways — you  can 
spring  it  down  toward  the  toes,  or  you  can  work  with  both  hands  be- 
neath the  instep  and  spring  it  toward  the  sides.  In  doing  that  the  prin- 
ciple is  that  you  stretch  the  ligaments  about  the  tarsal  joints.  You 
can  stretch  the  ligaments  at  the  articulation  of  the  ankle  by  this  forward 


206  DISLOCATIONS   OF   HIP.    KNEE   AND   ANKLE. 

and  backward  movement  and  by  working  it  from  side  to  side.  By 
breaking  the  two  arches  of  the  foot  as  I  have  shown,  you  can  relax  all 
of  the  ligaments  across  the  arch  of  the  instep.  Of  course  the  toes  can 
also  be  treated  in  the  same  way.  We  frequently  are  called  to  treat  for 
corns  along  with  the  rest  of  our  treatment.  When  you  are  treating 
a  toe,  you  know  the  vessels  run  down  the  outside;  spring  it  from  one 
side  to  the  other;  that  will  stretch  the  ligaments  and  the  blood  vessels 
and  stimulate  the  nerves. 

Q.     Would  that  treatment   cure  a  cramp   in   the  foot? 

A.  It  would  depend  on  the  cause,  if  the  cause  were  in  the  foot  it 
might.  You  could  very  well  cure  some  cases. 

Q.     Would  it  cure  cramps  on  the  bottom  of  the  foot? 

A.  It  would  depend  upon  where  your  obstruction  was;  it  might  be 
higher  in  the  nerve  path.  You  would  have  no  trouble  in  curing 
it  in  the  foot ;  I  have  found  that  in  my  own  ^case,  by  simply 
stretching  it.  Every  one  naturally  does  that;  some  peonle  are  much 
troubled  by  cramping  in  the  feet. 

It  frequently  becomes  the  duty  of  the  Osteopath  to  STRETCH  THE  SCI- 
ATIC NERVE  by  stretching  in  this  way ;  placing  the  heel  of  the  patient  over 
operator's  shoulder,  keeping  the  knee  straight,  and  then,  since  the  branches 
of  the  nerve  run  on  down  over  the  plantar  surface  of  the  foot,  pull  down  on 
the-  toe  and1  you  can  stretch  the  sciatic  nerve  considerably.  Also,  in  the 
treatment  of  sciatica  it  is  one  of  the  treatments  to  rotate  the  limb  out- 
ward, thus  to  relax  the  muscles  throughout  the  whole, course  of  the 
sciatic  nerve,  or,  by  an  inward  turn,  relax  the  pyriformis  and  those  short 
muscles,  the  external  rotators  which  may  impinge  upon  the  nerve. 

As  to  DISLOCATIONS. — Frequently  you  meet  a  dislocation  of  the  ankle. 
The  foot  may  be  thrown  outward,  in  which  case  you  ha've  an  inward 
dislocation:  or  it  may  be  the  reverse,  or  these  bones  may  be  thrown 
forward  upon  the  ankle,  in  which  case  you  have  a  forward  dislocation. 
In  a  few  cases  you  have  a  'backward  dislocation.  The  movement  is  to 
have  your  patient  lying  down,  flex  the  thigh  at  a  right  angle,  have  your 
assistant  fix  the  knee  so  that  he  can  exert  counter-extension,  then  you 
exert  traction  and  bend  the  foot  in  the  direction  in  which  it  would  go. 
if  it  was  thrown  outward  stretch  it  and  bend  it  inward,  and  vice  versa. 
We  do  this  in  the  case  of  the  toes,  simple  extension  is  the  method  em- 
ployed. 

In  the  case  of  the  knee  the  dislocations  also  are  four;  inward  or 
outward,  forward  or  backward.  It  is  said  simple  extension  is  enough. 
However,  the  Osteopath  uses  this  movement :  he  flexes  the  thigh  at  a 
right  angle,  and  then  reaching  in  at  the  popliteal  space  he  grasps  both 
the  internal  and  external  hamstring  tendons  and  pulls  outward  with  the 
idea  of  spreading  them,  dra\ying  them  away  from  the  prominences  at 


DISLOCATION    OF   THE    HIP.  207 

the  end  of  the  femur;  and  then  he   pulls  with   considerable  tension  and 
attempts  to  spring  the  joint  back  into  place. 

Dislocation  of  the  knee  is  rather  serious,  as  it  is  especially  apt  to  be 
followed  by  inflammation. 

As  to  the  HIP.  There  are  four  dislocations  described  for  the  hip.  One 
is  upward  and  backward  upon  the  dorsum  of  the  ilium,  in  which  case 
the  leg  is  shortened  and  the  toes  are  turned  inward.  Another  is  back- 
ward into  or  near  the  sciatic  notch,  in  which  case  also  the  limb  is 
shortened,  though  not  so  much,  and  the  toes  are  turned  inward.  The 
third  is  forward  into  or  near^the  obturator  foramen,  and  is  called  the 
thyroid  dislocation.  It  is  the  most  difficult  with  which  we  have  to  deal, 
and  when  such  is  the  case  the  knee  is  bent,  the  toes  point  to  the  ground 
and  may  rotate  inward  or  outward.  In  the  other  case  the  head  of  the 
femur  if  forward  upon  the  pubic  arch,  and  the  turn  of  toes  is  invariably 
outward.  So  you  have  two  in  which  deflection  of  the  toes  is  always  in- 
ward, one  in  which  it  may  be  inward  or  outward,  and  one  in  which  it  is 
invariably  outward.  Dislocations  when  they  are  new  are  fairly  easy  to  re- 
duce, but  the  Osteopath  gets  them  almost  always  when  they  are  old. 

Your  treatment  must  first  be  directed  to  softening  all  the  ligaments 
and  the  muscles,  removing  the  unnatural  tension,  and  thus  get  the  hip 
ready  to  set.  These  old  cases  are  almost  always  slow  to  set,  though  I 
have  seen  some  long  standing  cases  set  in  a  few  treatments.  You  always 
have  two  factors  of  great  aid  to  you,  one  is  the  anterior  "Y"  ligament 
of  the  hip  joint,  and  the  other  is  the  action  of  the  small  muscles,  the 
pyriformis,  obturator  internus  and  externus,  the  two  gemelli,  and  the 
quadratus  femoris.  They  are  attached  in  such  a  way  as  to  draw  on  the 
great  trochanter.  When  it  is  up,  they  are  below,  consequently  they  are 
of  great  importance  to  us  in  setting  a  hip.  If  the  hip  is  up  and  back. 
you  flex  the  thigh  still  more,  turn  it  inward  strongly  until  you  get 
the  tension  of  those  muscles,  and  then  rotate  the  knee  outward,  and  get 
the  head  of  the  femur  to  travel  over  the  edge  of  the  ascetabulum.  That 
looks  easy,  but  I  will  assure  you  it  is  not.  When  it  is  dislocated  back- 
ward into  the  sciatic  notch,  the  idea  is  to  flex  the  thigh,  work  the  knee 
inward  to  disengage  the  head  of  the  femur  from  the  notch,  and  then 
rotate  it  outward  and  forward,  and  you  get  the  head  of  the  femur  drawn 
toward  the  ascetabulum.  When  the  dislocation  is  forward  into  the 
obturator  foramen  you  are  usually  in  difficulty.  The  motion  described 
for  that  is  to  flex  the  knee  and  to  rotate  it  inward,  using  the  attachment 
of  the  "Y"  ligament  as  a  fulcrum  against  which  the  limb  works.  Flex 
the  thigh  and  work  the  head  of  the  femur  outward,  or  toward  the 
cotyloid  notch.  In  the  fourth  dislocation,  where  the  head  of  the  femur 
is  over  the  brim  of  the  pelvis,  considerable  tension  is  exerted  back- 


208  DISLOCATION   OF   THE   HIP. 

ward,  long  enough  to  stretch  these  ligaments,  and  then  try  to  lift  the 
head  of  the  femur  over  the  arch.    I 

In  diagnosing  of  the  hip  dislocations  you  frequently  find  it  very 
difficult.  If  the  dislocation  is  backward  into  the  sciatic  notch,  the  lirnt* 
will  be  a  little  shorter,  the  toes  will  be  turned  in,  and  when  the  patient 
sits  up  you  have  a  shorter  limb.  While  if  it  is  forward  it  always  length- 
ens the  limb  for  the  patient  to  sit  up  upon  the  table.  As  I  have  said,  the 
hips  get  out  and  stay  out  for  a  great  length  of  time,  and  we  have  a 
great  deal  of  trouble  in  getting  them  back.  Of  all  the  dislocations,  the 
most  difficult  to  treat  is  the  one  into  the  obturator. 


LECTURE  XXVIII, 

There  are  two  or  three  points  to  which  I  neglected  to  call  your  atten- 
tion at  the  last  time.  I  mentioned  treating  the  prostate  gland,  but  did  not 
show  you  how  to  treat  it.  You  know  how  to  find  the  gland,  and  work- 
ing down  across  it  on  each  side  with  a  fairly  firm  pressure,  just  to 
stimulate  the  flow  of  blood  through  it,  is  the  motion  employed. 

Also,  as  to  the  saphenous  opening,  we  treat  that  by  stretching  the  thigh 
which  has  been  flexed,  outward;  that  will  enable  you  to  stretch  the 
muscles  about  that  opening,  then  by  rotating  the  limb  inward  and  relaxing 
the  muscles,  you  can  work  your  fingers  in  at  the  opening;  you  stretch  the 
muscles  about  it  and  free  the  opening. 

Tenesmus  in  the  lower  bowel  occurs  frequently  in  diarrhoea  and  in 
other  troubles.  This  can  be  relieved  by  working  over  the  sacrum,  espe- 
cially over  the  muscles,  to  stimulate  and  thus  cause  a  contraction  of  the 
sphincter  and  a  relief  of  the  feeling  of  tenesmus. 

Frequently  after  paiturition  the  disease  known  as  milk  leg,  or  phleg- 
masia  dolcns,  occurs,  and  is  probably  due  to  a  contraction  of  some  of  the 
short  muscles,  probably  the  pyriformis;  it  sometimes  happens  that  the 
hip  has  been  thrown  out  in  the  efforts  of  parturition.  Always  after 
attending  such  a  case  the  hip  should  be  turned  to  see  that  it  is  properly 
in  place,  and  see  that  the  muscles  are  properly  stretched.  The  saphenous 
veins  should  be  treated  also.  ' 

Q.     How  would  you  treat  for  fainting? 

A.  By  the  common  methods  employed — anything  to  lower  the  head; 
some  people,  for  instance,  when  they  know  they  are  going  to  faint,  as 
some  do,  will  drop  over  the  back  of  a  chair,  with  the  head  down,  and 
that  will  stop  it.  When  such  has  occurred,  get  the  head  of  the  patient 
lower  than  the  feet,  you  can  have  him  hang  his  head  over  the  end  of 
the  table  at  the  foot;  or  you  may  shock  him,  pull  the  hair,  or  a  slap  will 
draw  the  blood  to  the  head  when  it  is  exhausted. 


QUESTIONS.  209 

Q.  I  have  a  case  in  mind  in  which  bleeding  of  the  nose  occurred 
and  lasted  four  or  five  hours  before  it  was  stopped,  and  the  patient 
finally  died.  What  would  be  the  treatment? 

A.  To  check  epistaxis  or  bleeding  from  the  nose  we  work  in  the 
superior  cervical  region,  stimulating;  that  is  frequently  of  use.  Or  you 
may  hold  the  facial  artery  where  it  crosses  the  angle  of  the  jaw,  or  hold 
the  nasal  branches  just  here  at  the  inner  canthus  of  the  eye.  Hold  them 
strongly.  That  is  the  usual  treatment,  particularly  the  stimulation  in 
ihe  cervical  region.  ' 

Q.  In  case  of  a  lady  whose  babe  is  about  fifteen  months  old;  since 
the  birth  of  her  child  she  has  had  an  extremely  sore  mouth,  the  con- 
dition of  the  alimentary  canal  has  been  such  that  she  could  eat  but  a 
very  light  diet;  diarrhea  all  the  time,  and  a  gradual  wasting  away  of 
her  strength  and  muscular  system  until  she  is  almost  a  skeleton.  What 
could  be  done  Osteopathically? 

A.  It  is  the  disease  known  among  the  medical  profession  as  nurse"s 
sore  mouth.  What  we  would  describe  as  a  general  treatment  should 
be  given;  a  general  spinal  treatment  to  tone  up  the  nervous  system  par- 
ticularly, reaching  especially  the  centers  for  the  bowels,  the  splanchnics, 
and  reaching  also  the  kidneys  and  the  liver,  toning  up  the  secretory  and 
excretory  organs,  and  keeping  the  system  in  as  good  a  condition  as 
possible.  I 

Q.  In  the  case  of  a  person  taking  a  hard  cold,  or  the  disease 
known  as  la  grippe,  how  would  you  treat? 

A.  I  would  give  a  strong  stimulating  treatment.  That  is  a  thing 
that  is  very  important.  I  have  already  spoken  of  the  effects  of  la  grippe 
several  times,  and  I  have  found  the  most  serious  results  following  it 
after  a  long  period  of  time.  Have  the  patient  on  the  face  for  the  first 
and  loosen  all  the  muscles.  This  treatment  will  also  apply  to  what  is 
called  a  bad  cold.  I  have  had  some  excellent  results  in  treating  bad 
colds,  and  you  can  usually  cure  them.  Use  this  general  treatment. 
With  the  condition  brought  about  by  la  grippe  there  is  usually  a  pain- 
ful aching  in  the  back,  especially  along  the  lumbar  region.  I  then  have 
the  patient  on  the  side,  and  having  loosened  the  muscles  as  shown,  I 
would  spring  the  spine  all  along  by  working  underneath;  you  know  the 
various  motions.  You  can  separate  the  pelvis  and  the  shoulder  by  put- 
ting your  two  arms  between  them  and  springing  the  spine.  Then  for 
this  backache  in  the  lumbar  region,  I  would  go  particularly  to  the  fifth 
lumbar,  having  first  loosened  all  along  the  lumbar  region,  and  spring  the 
spine.  The  ache  there  is  probably  caused  by  the  tension  of  the  liga- 
ments, and  while  we  usually  use-  an  inhibiting  motion  to  free  one  from 
an  ache  or  pain,  it  depends  upon  what  it  is  caused  by.  If  it  is  caused 
by  the  contraction,  as  it  probably  is  in  such  a  case,  the  relaxation  of  the 


210  QUESTIONS. 

ligaments  should  do  the  work.  I  would  then  treat  for  the  kidneys,  with 
the  patient  on  the  back;  reach  underneath  and  stimulate  along  the 
region  of  the  lower  splanchnics  and  upper  lumbar.  I  would  also  in  that 
case  treat  the  liver  and  the  bowels.  Give  the  neck  a  thorough  treat- 
ment; I  have  already  explained  all  these  things  in  detail  in  going  over 
the  parts  of  the  body.  The  neck  is  a  part  of  the  spine,  and  you 
must  be  particular  in  watching  there  to  see  that  this  contracture  of  the 
deep  muscles  does  not  affect  important  nerves,  as  it  may  very  readily  do. 
Use  the  motions  given;  first  relax  all  the  muscles,  then  work  deeper 
and  spring^  the  neck  to  relax  the  ligaments.  You  can  work  from  side 
to  side,  and  before  completing  the  operation  I  would  give  the  straight 
pull,  and  the  bend  of  the  neck,  enough  to  raise  the  patient's  head  and 
shoulders  from  the  table.  That  motion  will  stretch  all  the  spine.  Then 
I  would  free  all  about  the  head  and  face,  the  points  of  the  fifth  nerve, 
those  places  at  which  you  know  how  to  reach  it.  To  free  the  nose 
press  firmly  upon  the  forehead,  spring  the  jaw  down,  and  work  thor- 
oughly at  the  styloid  processes.  It  would  not  hurt  to  work  the  arms 
and  lower  limbs,  in  fact,  go  all  over  the  system  to  loosen  any  structure, 
either  muscle  or  ligament,  which  may  be  contracted  by  the  effects  of 
la  grippe. 

Q.  What  would  you  consider  a  few  of  the  most  essential  points  in 
consideration  when  a  patient  first  comes  to  see  you? 

A.  That  is  a  very  good  question,  because  it  involves  the  question 
of  how  to  start  about  an  examination.  I  would  first  take  the  pulse; 
it  is  my  habit  to  do  so,  I  do  not  know  that  it  is  necessary  always;  others, 
I  believe,  do  not  do  it,  but  the  pulse  is  always  considered  an  indication 
in  diseases.  I  would  then  go  to  the  spine  and  examine  it  thoroughly, 
but  of  course  I  would  be  questioning  them  as  I  went  concerning  all  the 
symptoms.  In  fact,  before  taking  the  pulse  I  would  ask  them  all  about 
the  trouble;  I  would  get  the  subjective  symptoms. 

Q.     Do  you  think  the  history  of  the  case  is  essential,  then? 

A.    Yes,  sir,  it  is. 

Q.     Please  give  the  treatment  for  goitre. 

A.  For  goitre  we  would  give  essentially  neck  treatment.  Frequently 
goitre  is  caused  by  an  obstruction  of  the  thyroid  veins.  However,  I  think 
it  is  often  caused  by  some  impingement  upon  the  nerves  supplying  the 
arteries  and  veins,  consequently  you  have  an  obstruction  there.  The  idea 
would  be  to  thoroughly  relax  all  the  muscles  and  ligaments  about  the  neck, 
give  the  neck  the  straight  pull  and  the  turn  from  side  to  side,  and  bend  it 
backward,  since  there  are  anterior  muscles  in  the  neck  which  you  must 
take  into  consideration.  Sometimes  it  is  those  muscles  which  are  con- 
tracted and  are  pressing  down  upon  the  nerves  and  vessels.  If  it  is  a  hard 


QUESTIONS.  •  211 

goitre  with  a  fibrous  capsule,  it  is  very  difficult  to  cure.  If  it  is  an  ex- 
ophthalmic goitre  you  will  have  difficulty  in  curing  it.  but  the  ordinary 
goitre  is  dealt  with  with  considerable  success,  although  it  frequently  takes 
a  long  time.  In  treating  for  goitre  I  would  also,  besides  the  general 
treatment,  work  locally  over  the  thyroid  gland,  which  you  know  is  the 
gland  enlarged  in  goitre,  work  across  it  from  side  to  side,  to  free  the  veins. 
Raise  the  clavicles. 

Q.  How  would  you  treat  enlarged  parotid,  submaxillary  or  sublingual 
glands,  exceedingly  large  ones  ? 

A.     Do  you  know  what  caused  it? 

Q.     Not  unless  it  was  scrofula. 

A.  I  should  give  the  treatment  for  the  general  system  first ;  we  must 
get  rid  of  what  is  causing  it,  whether  it  be  impurities  in  the  blood,  or  a 
scrofulous  condition,  or  anything  of  that  kind.  Any  case  would  depend 
upon  general  causes  to  some  extent,  and  you  would  have  to  give  a  general 
treatment  to  purify  the  blood.  That  is,  attend  to  all  the  avenues  of  secre- 
tion and  excretion  and  of  assimilation  and  nutrition  in  general.  The  local 
treatment  would  then  be  confined  to  loosening  all  the  parts,  and  freeing 
the  blood  and  nerve  supply  to  the  organs  affected. 

Q.     Please  give  the  treatment  for  reduction  of  fevers. 

A.  In  the  first  place  it  is  said  that  when  there  is  fever  in  the  body 
that  it  is  made  by  the  refuse  not  being  cast  off,  and  hence  being  burned. 
Nature  is  making  an  extra  effort  to  burn  the  refuse,  and  hence  is  causing 
fever.  Whether  that  be  true  or  not,  you  know  that  there  is,  in  many  cases, 
almost  a  complete  suppression  of  urine  in  fever,  or  if  not  so  much  as  that, 
that  the  urine  is  scanty  and  high  colored.  You  must  go  to  the  kidneys  and 
free  their  action.  Go  also  to  the  bowels  and  free  their  action ;  combine  the 
general  treatment.  Look  for  the  cause ;  of  course  it  would  depend  upon 
what  kind  of  fever  it  Was ;  and  then  having  treated  the  particular  cause,  the 
Osteopath  also  goes  to  the  superior  cervical  ganglion,  and  causes  a  general 
.vaso-dilator  effect.  You  can  inhibit  the  superior  cervical  ganglion  either 
opposite  the  transverse  processes  or  in  the  sub-occipital  fossae.  Then  give 
the  treatment  in  the  upper  dorsal  region,  stimulating  the  action  of  the 
lungs  to  help  them  to  carry  off  the  poisonous  matter  in  the  body.  Also 
treat  the  splanchnics.  In  general,  go  to  the  cause.  I  suppose  you  have 
heard  Dr.  Still's  theory  of  fever — he  says  that  the  lung  is  not  acting 
properly,  that  the  gases  are  not  properly  condensed,  and  he  treats  fevers 
through  the  lung  a  good  deal,  to  get  it  to  act  properly  that  the  poisons  of 
the  body  may  be  excreted  properly. 

Q.     Would  you  treat  the  vagi  in  fever? 

A.  Yes,  sir,  we  would  treat  them  for  the  general  effect  on  the  liver 
and  intestines,  and  you  could  stimulate  them  to  inhibit  the  pulse.  Of 
course  you  have  not  cured  the  fever  simply  by  slowing  the  heart,  that  is  an 


212  QUESTIONS. 

adjuvant.  You  must  go  to  the  first  cause;  having  done  that  work  I  should 
also  go  to  the  splanchnics,  as  I  have  said,  and  should  inhibit  there ;  having 
inhibited  the  cervical,  I  would  inhibit  in  the  middle  dorsal  region  or  along 
the  splanchnics,  and  then  I  would  go  to  the  fifth  lumbar,  where  you  get 
the  center  for  the  hypogastric  plexus  and  through  it  the  pelvic  plexuses. 
Your  object  in  doing  that  is  to  dilate  the  vessels;  inhibit  the  vaso-con- 
strictors  and  stimulate  the  vaso-dilators,  or  you  tend  to  restore  things  to 
the  normal.  In  other  words,  you  free  the  parts  affected,  and  dilate  the 
abdominal  veins.  In  that  way  you  equalize  the  circulation.  That  is  just 
part  of  your  general  work,  and  it  depends  on  the  kind  of  fever ;  in  typhoid 
fever  you  have  to  go  to  the  intestines  and  treat  them. 

Q.     How  do  you  treat  chills? 

A.  Stimulate  the  heart  to  propel  the  blood  faster ;  stimulate  the  lungs 
so  that  the  blood  will  be  better  purified  and  warmed. 

Q.  Where  the  fever  follows  the  chill  as  soon  as  it  is  over,  would  you 
begin  treatment  for  the  fever  at  once? 

A.  If  I  supposed  it  would  come  on  right  away,  I  would  be  on  the 
watch  for  it;  I  do  not  know  that  I  would  begin  to  treat  immediately.  But 
having  taken  those  general  points  together,  I  would  also  combine  with  that 
general  spinal  treatment  and  treatment  for  the  heart,  a  general  stimulating 
treatment,  and  in  some  cases  it  might  not  hurt  to  stretch  the  limbs,  and 
do  all  you  can  to  stimulate  the  flow  of  blood  through  the  body.  In  chills 
and  fever  treat  especially  the  liver  and  spleen.  - 

Q.     Just  about  what  you  would  do  for  a  cold  or  la  grippe? 

A.  Largely  that  general  treatment.  Then  rapid  rubbing  upward 
along  the  spine,  hard  and  quickly,  will  cause  a  chill  to  cease.  On  one  of 
the  hot  days  last  summer  I  was  called  to  a  case;  it  was  not  a  regular  chill, 
but  the  person  had  become  over-heated,  and  the  blood  had  left  the  surface 
of  the  body.  He. felt  extremely  faint,  had  difficulty  in  standing  up,  and 
was  covered  with  a  cold,  clammy  perspiration ;  the  surface  of  the  body  was 
chilly.  I  immediately  stimulated  the  heart  and  lungs,  inhibited  at  the 
superior  cervical,  and  gave  a  general  treatment  to  equalize  the  blood  and 
keep  it  circulating.  I  had  the  patient  keep  quiet  and  he  soon  felt  all  right. 

Q.  I  would  like  to  know  what  treatment  you  would  give  for  vaso- 
dilator effect  and  for  vaso-constrictor  effect,  to  inhibit  the  flow  of  blood  or 
increase  it? 

A.  I  do  not  know  that  I  would  give  any  in  that  way.  For  instance, 
go  to  the  splanchnics,  they  contain  both  vaso-dilators  and  vaso-con- 
strictors;  go  to  the  sciatics,  they  also  contain  both.  Now,  I  cannot  treat 
the  sciatic  or  the  splanchnics  and  cause  that  particular  set  of  fibers  to  act 
alone,  that  is,  I  do  not  know  that  I  can,  and  frequently  I  employ  a  method 
which  I  say  will  inhibit  and  frequently  do  that  which  we  say  will  stimulate, 
and  no  doubt  we  do  so.  It  is  very  hard  to  say  just  what  we  do  there,  I 


QUESTIONS.  213 

tend  more  and  more  to  the  belief  that  we  simply  restore  something  that  is 
abnormal  to  the  normal  condition,  and  allow  nature  to  do  the  rest.  I 
think  that  is  the  best  theory  by  which  we  can  explain  so  many  things, 
while  there  are  many  things  we  cannot  explain  by  the  theory  of  stimula- 
tion and  inhibition. 

Q.  If  a  person  faints  from  overheating,  is  there  not  any  special  treat- 
ment-besides  holding  the  head  down.  Dr.  Charley  Still  seems  to  have  had 
good  results  in  that  trouble? 

A.  In  such  a  case  you  would  also  have  to  direct  your  attention  to  the 
general  condition.  In  case  of  overheating,  where  there  is  an  inward  con 
gestion,  very  likely  the  blood  is  prevented  from  flowing  to  the  head  and  is 
congested  about  the  lungs  particularly,  and  about  the  intestines,  since  there 
the  veins  dilate  the  most  readily  and  hold  the  most  blood.  You  would  have 
to  apply  your  stimulating  treatment,  and  cause  the  blood  to  circulate 
freely. 

Q.     Give  us  a  treatment  for  diphtheria. 

A.  Diphtheria,  of  course,  is  a  constitutional  trouble.  You  will  have 
to  prevent  the  membrane  forming  if  possible,  and  that  can  be  done. 
Dr.  Charley  Still  has  had  the  very  best  experience;  more  than  any 
other  Osteopath.  He  had  a  remarkable  run  of  cases  in  Red  Wing,  Min- 
nesota, and  had  remarkable  success.  His  treatment  was  very  largely  about 
the  neck  and  throat ;  he  would  treat  there  to  keep  the  blood  supply  open ; 
you  know  how  to  do  it,  free  all  the  muscles  and  ligaments,  and  especially 
keep  the  anterior  muscles  softened  and  loose  so  that  there  can  be  no  tension 
there  or  stoppage  of  the  blood,  allowing  an  excretion  to  grow  in  the  throat 
and  form  a  membrane.  You  must  attend  to  the  bowels  and  the  kidneys 
and  the  general  health. 

Q.     When  the  membrane  does  form,  what  do  you  do? 

A.  Cause  the  patient  to  vomit  is  one  way,  in  order  to  throw  it  out, 
and  there  are  certain  drinks  that  they  use  to  loosen  the  membrane. 

A.  Dr.  Charley  Still  said  that  he  frequently  would  come  back  to  a 
case  inside  of  fifteen  or  twenty  minutes.  He  was  unprotected  by  the  law 
and  he  had  to  go  very  carefully,  or  he  would  have  had  trouble. 

Q.     Did  he  treat  for  the  fever? 

A.  Yes,  you  would  have  to  treat  for  that  according  to  the  treatment 
outlined. 

Q.  In  any  acute  trouble  of  that  kind  would  you  just  treat  for  the 
symptoms  you  see,  unless  you  find  some  lesion? 

A.  No,  sir,  that  is  hardly  our  method,  you  should  try  to  find  a  lesion, 
in  the  spine  particularly,  and  you  would  probably  be  successful. 

Q.     Suppose  you  did  not  find  a  lesion? 


214  QUESTIONS. 

A.  If  you  didn't  find  a  lesion  you  could  only  go  according  to  prin- 
ciples and  work  on  the  centers  indicated,  but  you  will  find  lesions,  con- 
tracted muscles,  or  something  of  that  kind. 

Q.     Give  the  treatment  for  granulated  eyelids. 

A.  In  granulated  eyelids,  first  you  must  turn  back  the  lids  and 
examine  them.  Usually  there  is  considerable  irritation,  and  the  eyeball  is 
inflamed,  then  you  will  see  the  granulations  existing  as  little  white  points 
all  along  on  the  inside  of  the  lid.  You  may  find  them  on  both  lids.  Our 
treatment  there  locally  is,  after  having  wet  the  finger  with  a  little  soap 
suds  or  vaseline,  to  gently  work  all  along  under  the  edge  of  both  lids  and 
to  rub  on  the  outside  of  the  lids  as  you  go  along ;  that  will  crush  the  granu- 
lations. Some  say  that  the  granulations  are  caused  by  the  stoppage  of 
the  ducts  of  the  Meibomian  glands.  Dr.  Still,  however,  says  that  there  is 
some  obstruction  to  the  veins,  that  the  blood  is  brought  to  the  eye  and 
cannot  get  away,  consequently  it  must  do  something,  and  it  goes  to  work 
to  build  up  some  growth.  That  seems  to  be  the  most  reasonable  theory.  If 
you  want  to  know  particularly  about  granulated  eyelids,  ask  Dr.  Hildreth : 
he  had  quite  a  remarkable  case,  which  Dr.  Still  cured.  Having  treated 
the  granulations,  treat  the  points  of  the  fifth  nerve  over  the  eye  here,  on 
the  forehead,  at  the  inner  and  outer  canthus-  of  the  eye,  and  at  the  supra 
and  infraorbital  foramina,  to  free  the  blood  flow.  Treat  particularly 
through  the  upper  cervical  region,  and  look  for  any  lesion  in  the  cervical 
region ;  give  the  general  treatment  for  the  neck  in  order  to  keep  the  blood 
supply  freely  open  to  the  eye. 

Q.  Where  the  upper  lid  is  drooping,  would  you  give  the  same  treat- 
ment? 

A.  I  would  there  stimulate  the  flow  of  blood  and  would  stimulate  the 
fifth  nerve,  since  it  is  a  muscular  trouble,  and  you  must  tone  up  the 
muscles  and  strive  to  get  them  built  up  through  the  blood  flow. 

Q.     Do  you  give  the  same  treatment  for  cataract? 

A.  You  would  treat  particularly  through  the  fifth  nerve  for  cataract, 
as  the  fifth  nerve  has  to  do  with  nutrition  of  the  eye,  especially  its  an- 
terior part.  You  reach  it  through  the  superior  cervical,  at  the  inferior 
maxillary  articulation,  and  through  these  points  that  I  have  mentioned 
over  the  face.  Also  look  for  any  lesion  in  the  cervical  region  or  in  the 
upper  dorsal.  Give  the  general  treatment  of  the  neck. 

Q.  In  case  of  the  eyeball  turning  inward,  for  instance  the  right  one, 
through  weakness  of  either  the  external  muscles  or  increased  strength  of 
the  other  muscles,  what  do  you  do? 

A.  Some  cases  of  crossed  eyes  have  been  successfully  treated  Osteo- 
pathically.  I  have  known  of  cases  being  treated  surgically,  which  is 
always  to  cut  a  few  fibers  of  the  muscle  which  is  opposite  to  the  one  af- 
fecting the  eye  most — on  the  side  pulling  the  most  strongly;  that  weakens 
that  muscle  and  allows  its  antagonist  to  be  more  evenly  balanced  in  its 


'QUESTIONS.  215 

action.  That  will  allow  the  eye  to  become  straight.  But  the  trouble 
with  that  operation  is  that  after  the  person  has  gotten  well  and  the  gen- 
eral health  has  increased,  this  weak  muscle,  if  the  trouble  was  of  this 
muscle,  will  strengthen  and  pull  too  hard  against  the  one  which  has  been 
weakened  by  the  operation.  I  have  heard  of  such  cases.  The  treatment 
there  Osteopathically  would  be  to  strengthen  the  muscles.  I  have  heard 
of  a  number  of  cases  being  treated.  They  are  often  successful. 

Q.  This  is  a  case  of  a  party  about  middle  age  and  it  came  on  sud- 
denly. 

A.  I  would  by  all  means  try  it  in  all  such  cases;  where  is  comes  on 
suddenly  that  way  it  may  be  a  nervous  trouble,  it  may  be  a  slip  in  the 
neck  somewhere.  I  would  not  send  the  patient  away  and  say  I  could  not 
cure  him,  not  unless  I  was  positive.  It  is  pretty  hard  to  be  certain.  In 
some  cases  the  Osteopath  can  not  tell  until  he  has  tried,  and  if  he  is 
conscientious  he  must  treat  his  patients  awhile  before  he  is  sure. 

Q.     How  would  you  treat  for  pneumonia? 

A.  In  pneumonia  the  trouble  is  usually  handled  very  nicely.  The 
patient  will  have  fever  besides.  The  simple  Osteopathic  treatment  is  to 
stimulate  the  lungs,  as  I  have  shown,  in  the  upper  dorsal  region  all  along 
on  both  sides.  Find  out  particularly  which  one  is  affected  by  the  methods 
which  I  have  shown  you.  Treat  for  the  fever.  In  children  and  old 
people  it  often  follows  measles  or  is  a  complication  of  them,  and  if  you 
are  called  to  a  case  of  measles  do  not  forget  that  complication;  in  all 
cases  look  out  for  pneumonia. 

Q.  Is  there  any  wa'y  in  which  severe  coughing  can  be  stopped  im- 
mediately? 

A.  It  will  depend  upon  the  cause  of  the  trouble.  If  I  were  called  to 
such  a  case  about  the  first  thing  I  would  do  would  be  to  examine  the 
pneumogastrics  to  see  whether  or  not  there  was  some  irritation  in  the  neck 
affecting  them.  Or  if  I  could  not  find  it  I  would  inhibit  the  action  of  the 
pneumogastrics.  There  are  laryngeal  branches  supplying  the  larynx 
which  may  t>e  irritated,  causing  severe  coughing.  It  may  be  some  irrita- 
tion of  the  pneumogastric  in  the  stomach  that  is  irritating  the  nerves  and 
causing  the  coughing. 

Q.     What  would  you  do  when  it  is  caused  from  the  lungs? 

A.     I  would  give  a  general  treatment  to  the  lungs. 

Q.  In  case  the  heart  ceases  to  beat  for  a  short  time,  say  during 
sleep,  and  the  person  awakens  and  cannot  breathe  until  he  has  got  on  his 
feet,  what  would  you  do? 

A.  I  would  raise  the  ribs  on  the  left  side.  I  would  draw  the  arm 
back  strongly  while  holding  my  other  hand  in  a  V  shape  under  the 
angles  of  the  ribs.  What  you  describe  is  probably  palpitation,  and  may 
be  nervous  in  origin.  The  idea  there  is  that  you  give  the  heart  more 


216  QUESTIONS, 

room  mechanically,  by  raising  the  ribs,  and  that  you  stimulate  the  sympa- 
thetics  along  the  spine,  which  we  reach  along  the  upper  dorsal. 

Q.     Give  the  treatment  for  rheumatism. 

A.  There  are  several  kinds  of  rheumatism.  In  any  case  we  go  to 
the  kidneys.  We  treat  them  always  in  the  manner  shown,  to  free  the  system 
of  the  acid  which  is  present  in  case  of  rheumatism.  Sometimes  chronic 
rheumatism  comes  on  without  any  other  previous  form,  that  is,  it  begins 
as  articular  rheumatism,  and  will  strike  one  joint,  say  the  shoulder,  and 
next  it  will  be  in  the  knee  of  the  opposite  side,  the  following  day  it  will 
be  in  the  forearm,  then  in  the  wrist,  and  it  jumps  about  from  place  to 
place.  In  such  a  case  we  would  stretch  the  joint;  separate  it.  I  would 
also,  for  the  shoulder,  work  along  the  dorsal  region,  loosening  the  mus- 
cles there;  then  I  would  stimulate  at  the  origin  of  the  brachial  plexus, 
along  the  scaleni  muscles,  between  which  the  'branches  of  the  plexus  run 
out  to  the  arm;  raise  the  clavicle,  stimulale  the  subclavian  artery,  and  in 
general,  thoroughly  relax  everything  about  that  arm  and  free  the  forces 
of  life  to  it.  I  would  do  that  for  any  joint  affected.  In  case  of  muscular 
rheumatism  you  must  treat  very  gently,  treat  the  blood  and  nerve  supply 
to  the  part,  and  work  over  the  muscles  affected.  That  is,  bring 
gentle  pressure  and  stretch  them.  I  have  known  of  a  case  of 
general  muscular  rheumatism  where  we  simply  went  over  the  patient, 
gave  him  a  gentle  treatment,  stretched,  the  muscles  and  the  ligaments, 
and  stimulated  the  kidneys  and  the  liver  and  the  general  excretory  organs. 

Q.     What  is  the  treatment  for  flux? 

A.  The  same  as  for  diarrhea.  I  believe  I  showed  that  at  one  time. 
The  chief  thing  which  we  do  is  to  work  strongly  along  the  lumbar  re- 
gion, spring  the  spine  strongly,  and  hold  against  it.  I  have  seen  cases 
treated  in  that  way,  the  knees  against  your  abdomen,  and  hold  against 
the  eleventh  and  twelfth  ribs,  inhibiting  the  action  of  the  nerves  to 
stop  the  rapid  peristalsis.  That  is  the  theory.  You  can  do  that  by  set- 
ting the  patient  up  in  a  chair,  place  your  knee  against  the  heads  of  the 
eleventh  and  twelfth  ribs,  and  pull  the  arms  up.  and  back.  You  thus  get 
a  strong  pressure  against  this  point.  I  would  also  stimulate  the  flow  of 
bile.  I  described  to  you  not  long  ago  a  case  of  flux  of  long*  standing; 
in  that  case  I  found  that  the  two  lower  ribs  were  too  close  together  on 
each  side,  and  that  there  was  a  contraction  and  smoothness  along  the 
lower  lumbar  region.  I  relaxed  that  and  straightened  the  ribs,  and  .it 
took  but  two  treatments  to  cure  the  case. 

Q.     Please  give  the  treatment  for  catarrh. 

A.  That  is  general  treatment  of  the  neck,  and  is  what  I  have  already 
given,  but  I  might  mention  a  few  points.  They  say  always  that  there  is 
a  tender  place  under  the  angle  of  the  jaw.  The  theory  is  that  some 


QUESTIONS.  217 

contraction,  either  recent  or  of  long  standing,  is  shutting  off  the  blood 
supply  to  the  membranes  of  the  throat  and  nose. 

Q.     Do  you  treat  in  the  mouth? 

A.  We  sometimes  treat  through  the  mouth.  You  can  put  the 
finger  back  and  work  from  the  top  of  the  palate  down  along  the  pillars 
of  the  fauces  on  each  side;  we  sometimes  do  that. 

Q.     How  would  you  treat  a  sprained  ankle  or  knee? 

A.-  Say  it  were  the  knee,  you  must  be  very  careful,  if  it  is  a  recent 
case  and  there  is  a  swelling  about  it  you  must  take  the  swelling  down. 
1  would  not  move  the  member  much  at  first,  and  the  best  way  that  I 
know  to  reduce  a  congested  condition  from  inflammation  after  severe 
strain  is  by  the  use  of  hot  water,  hot  bandages,  or  the  hot  water  bottle. 
After  having. reduced  the  swelling  you  can  see  if  the  parts  are  dislocated; 
examine  to  see  if  they  are  out  of  place  or  if  there  is  any  fracture.  Of 
course  if  you  are  called  at  once  to  the  case  you  can  find  that  out  at  once. 
You  should  always  do  that  as  early  as  possible;  find  out  if  there  are  any 
dislocated  parts,  and  if  there  are  you  must  put  them  back  as  soon  as 
possible.  If  there  are  no  broken  or  dislocated  parts,  after  having  taken 
down  the  swelling,  principally  by  the  use  of  hot  applications,  I  would 
work  gently  at  the  popliteal  space  to  relax  the  muscles  and  stimulate  the 
popliteal  vessels,  then  I  would  bend  the  thigh  and  stretch  the  muscles 
about  the  saphenous  opening  to  allow  the  blood  flow  above  to  be  properly 
opened,  and  give  the  stretching  motion  to  the  leg  to  relax  its  muscles.  I 
should  then  treat  along  the  lower  part  of  the  spine,  especially  where  we 
reach  the  sacral  plexus,  so  as  to  stimulate  the  nerves  of  the  leg. 

Q.     Those  movements  would  be  rather  painful,  would  they  not? 

A.  You  would  have  to  be  very  careful,  perhaps  you  cannot  do  them 
at  first.  I  have  had  cases  of  sprain  where  I  would  not  manipulate  at  all 
for  several  days;  I  just  used  the  hot  applications  about  it,  and  watched  to 
see  that  no  trouble  took  place,  but  it  was  several  days  before  I  began  to 
manipulate.  At  first  you  can  treat  the  lower  part  of  the  spine  without 
moving  the  leg,  and  I  would  do  that.  In  these  cases  I  have  had  good 
success.  Sometimes  the  strain  will  not  be  painful,  and  you  can  manipu- 
late the  leg  from  the  start;  it  depends  altogether  on  conditions. 

Q.  Has  Osteopathy  come  in  contact  with  yellow  fever  or  cholera, 
and  if  so,  with  what  success? 

A.  Doctor  Still  says  he  has  treated  cholera.  I  do  not  know  that 
we  have  ever  had  any  cases  of  yellow  fever.  About  all  I  know  about  the 
treatment  for  cholera  is  that  Dr.  Still  says  he  treated  the  lungs,  he  was 
speaking  on  that  the  other  day  in  relation  to  his  theory  of  formation  of 
gases  in  the  lungs.  He  also  stimulated  the  excretions. 

Q.    What  is  the  treatment  in  Bright's  disease? 


218  QUESTIONS. 

A.  In  Bright's  disease  treat  for  the  kidney.  Bright's  disease  is  a 
general  name.  However,  it  refers  to  a  disease  of  the  parenchyma  of  the 
kidney,  and  there  are  various  forms.  You  would  have  to  look  for  any 
lesion  affecting  the  kidney  along  the  lower  dorsal  region  or  at  the  second 
lumbar,  and  your  idea  there  would  be  to  work  upon  the  nerve  supply  of 
the  kidney  by  treating  over  the  spine.  Then  you  could  work  at  the  um- 
bilicus, as  I  have  shown  you,  to  get  these  centers,  or  you  can  reach  them 
by  deep  pressure  over  the  renal  ganglia,  which  lie  on  the  renal  arteries. 

Q.  How  do  you  regulate  the  action  of  the  kidneys  when  they  are 
acting  too  frequently? 

A.  When  the  kidneys  are  acting  excessively  or  too  frequently,  the 
idea  is  that  you  must  find  any  lesion  which  may  cause  an  irritation  or 
inhibition  of  the  nerve  force.  It  is  frequently  confined  to  about  what  I 
have  said,  to  look  for  the  lesion  and  remove  it,  and  then  treat  along  the 
region  of  the  spine  where  we  get  the  nerves  to  the  kidneys. 

Q.     Stimulate  to  increase  the  action,  and  inhibit  to  lessen  it? 

A.  Well,  that  brings  us  back  to  the  question  of  just  what  we  do 
when  we  stimulate  or  inhibit  It  would  depend  upon  the  condition  there 
whether  I  would  spring  the  spine  and  work  in  such  a  way  as  to  stimulate 
or  whether  I  would  hold. 

Q.  If  there  was  too  much  secretion,  you  would  not  treat  in  the  same 
way  as  if  you  wanted  to  increase  it? 

A.  I  would  be  very  likely  to.  I  would  work  along  the  region  of  the 
spine  which  shows  there  is  some  obstruction  to  the  nerve  force,  and  my 
idea  would  be  to  remove  that  obstruction. 

Q.  Would  you  pull  on  the  neck  where  it  is  turned  to  one  side  or 
the  other,  and  turn  it? 

A.     I  would  not  pull  it  and  turn  it. 

Q.     I  mean  after  it  is  turned? 

A.  O,  yes;  I  would  not  be  afraid  to  do  that.  I  would  have  the  neck 
turned,  and  this  straight  pull  is  about  the  best  way,  but  I  would  not  pull 
it  and  turn  it,  because  you  are  likely  to  cause  trouble.  The  parts  are 
more  apt  to  be  stretched,  and  you  may  get  an  articular  process  out  of 
place. 

Q.  In  varicose  veins,  what  would  you  do  other  than  manipulate  the 
nerves  and  the  limbs? 

A.  I  would  work  along  the  lower  region  of  the  spine  and  stimulate 
the  sacral  nerves,  and  I  would  stretch  the  leg  thoroughly  to  stimulate 
the  sciatic,  since  the  sciatic  contains  the  vaso-motor  nerves  for  the  limbs: 
then  at  the  saphenotis  opening,  I  would  loosen  the  .tissues,  as  I  have 
already  told  you  how  to  do,  and  I  would  work  upward  from  the  varicose 
veins  along  the  course  of  the  veins  to  stimulate  the  flow  of  blood.  Do 
everything  to  build  up  the  tone  of  the  limb.  The  trouble  may  be  some- 


QUESTIONS.  219 

where  else,  but  it  is  most  frequently  in  the  legs,  from  standing  on  the 
feet  too  much. 

Q.     How  would  you  treat  neuralgia  of  the  heart? 

A.  I  would  confine  myself  there  to  the  upper  dorsal  region.  I 
would  go*  to  that  region  first  and  would  give  the  heart  all  the  room  to 
play  in  that  it  needed,  then  I  would  inhibit  at  the  superior  cervical  re- 
gion with  the  idea  of  inhibiting  the  nerve  force  and  quieting  the  spasm  if 
possible.  You  can  do  anything  to  reach  the  nerve  force  and  quiet  it.  It 
is  evidently  excited  and  there  is  evidently  some  irritation.  Your  idea  is 
to  find  the  cause  of  the  irritation  and  remove  it  if  possible.  It  may  be 
caused  by  some  poison  in  the  system,  then  you  would  have  to  remove 
the  original  cause  by  general  treatment.  The  trouble  is  frequently  in  the 
costal  cartilages,  or  in  luxated  ribs. 

Q.     How  would  you  treat  cerebral  troubles? 

A.     Through  the  neck,  it  depends  upon  the  case,  of  course. 

Q.  In  hay  fever  would  the  treatment  be  anything  different  from 
that  for  general  fevers? 

A.  Yes,  look  for  the  lesion  in  the  cervical  region  or  in  the  upper 
dorsal,  sometimes  the  first  rib  is  at  fault,  sometimes  the  clavicle,  and  you 
must  look  for  the  lesion  in  those  places.  We  do  not  have  the  ordinary 
symptoms  of  fever  in  hay  fever,  it  is  a  catarrh. 

Q.     How  would  you  treat  for  lumbago? 

A.  I  would  relax  everything  along  the  spine,  especially  in  the  lower 
part;  first  by  working  the  muscles,  then  by  flexing  the  knees  against 
me,  then  I  would  put  the  patient  into  a  chair  and  lift  up  and  turn  as  I 
lifted.  I  thin'k  the  theory  is  that  the  tension  of  the  ligaments  there  is 
affecting  the  nerves  and  causing  the  stiffness  of  the  muscles.  I  have 
seen  several  cases  treated  in  that  way  and  very  successfully. 

Q.     How  would  you  treat  apoplexy? 

A.  It -depends  upon  general  causes  and  conditions.  It  generally 
occurs  in  elderly  people,  where  they  are  not  used  to  much  exercise,  and 
perhaps  after  they  have  run  for  a  train  or  to  a  fire.  The  heart  is  ex- 
cited, and  the  vessels  being  weak  and  the  general  tone  of  the  system  being 
poor,  there  is  a  break  of  a  small  capillary  in  the  brain  and  the  formation 
of  a  clot,  Perhaps  it  does  not  extend  farther  than  congestion  of  the 
brain.  Sometimes  it  is  in  cases  of  people  who  have  long  been  bothered 
with  congestion,  and  the  blood  does  not  circulate  properly  through  the 
brain  or  body,  and  too  much  is  thrown  to  the  head.  You  would  have 
to  relieve  the  general  causes,  and  you  must  in  some  way  call  the  overplus 
of  blood  from  the  head.  In  that  case  you  would  treat  over  the  superior 
cervical  region  particularly,  and  then  to  get  your  effect  you  would  have 
to  work  over  the  solar  plexus  and  the  splanchnics  to  draw  the  blood  from 
the  head.  That  in  general  is  the  treatment.  Of  course  you  understand 


220  QUESTIONS. 

these  are  just  "snap  shots."  I  cannot  say  much  on  any  of  these  subjects 
here.  What  I  have  said  is  simply  as  far  as  time  allows. 

Q.     What  would  you  do  in  case  of  meningitis? 

A.  Meningitis  is  a  germ  disease  affecting  the  spinal  cord  ^itself.  I 
have  treated  chronic  cases.  In  the  case  of  an  infant  of  two  and  one-half 
or  three  years  of  age  the  symptoms  were  a  drawing  back  of  the  feet  until 
the  body  assumed  the  form  of  a  bow,  a  dribbling  of  saliva  from  the 
mouth,  a  lack  of  growth,  the  lower  part  of  the  body  being  undeveloped. 

In  an  acute  case  the  first  thing  to  do  would  be  to  give  a  hot  bath, 
evacuate  the  bowels;  everything  should  be  done  to  get  the  poison  out  of 
the  system;  when  that  was  done  I  would  give  the  patient  spinal  treat- 
ment, together  with  treatments  upon  the  kidneys,  liver,  bowels  and  lungs. 
I  am  treating  a  case  at  present  somewhat  similar  to  this. 

Q.  What  would  be  your  method  of  treating  the  spleen  when  there 
was  trouble  there? 

A.  I  would  raise  the  ribs  from  the  eighth  to  the  twelfth  on  the  left 
side,  correcting  any  obstruction  that  might  exist,  giving  the  abdominal 
treatment  to  help  remove  the  trouble.  In  malaria,  where  the  spleen  is 
congested,  free  the  blood  supply  by  working  from  the  eighth  to  the 
twelfth  dorsal  vertebra. 

Q,     How  would  you  cause  vomiting  by  Osteopathic  treatment? 

A.  This  is  sometimes  very  hard  to  cause.  Some  people  never 
vomit  no  matter  how  sick  they  get,  and  others  vomit  at  the  slightest 
provocation.  I  have  known  of  vomiting  following  manipulation  of  the 
solar  plexus,  and  also  upon  deep  pressure  in  the  third  left  intercostal 
space. 

Q.  Give  treatment  for  reducing  fever.  Is  there  any  way  to  keep  the 
fever  from  returning? 

A.  You  might  keep  it  down  temporarily.  I  have  seen  cases  of 
typhoid  fever  where  the  fever  was  kept  down,  but  evidently  the  cause  was 
not  removed.  Always  see  to  removing  the  cause. 

Q.     Is  there  any  effective  treatment  for  barber's  itch? 

A.  I  do  not  know.  I  would  open  the  pustules  with  a  sterilized 
needle,  and  sterilize  the  pustules  with-  carbolic  acid. 

Q.     What  is  the  treatment  for  colic? 

A.  Ordinary  wind  colic,  the  kind  that  babies  have  in  the  night,  is 
caused  by  a  disordered  digestion.  The  treatment  is  to  work  the  gas 
off  the  stomach,  then  stimulate  the  solar  plexus  and  work  along  the 
splanchnics. 

0-     Is  neuralgia  successfully  treated? 

A.  Yes,  the  treatment  for  neuralgia  is  by  inhibition.  Sometimes  it  is 
caused  by  poisonous  blood ;  sometimes  by  a  pressure  upon  the  nerves. 


QUESTIONS.  221 

Q.  In  case  of  a  paralysis  of  the  lower  limbs,  where  there  has  ap- 
parently been  no  circulation  for  three  years,  and  after  the  patient  had 
greatly  improved,  would  the  appearance  of  rash  or  boils  have  any  bearing 
upon  the  case?  Is  this  old  waste  matter,  which  has  been  dead  for  so  long, 
carried  off  in  this  way? 

A.  I  take  it  that  the  appearance  of  rash  would  be  a  good  symptom, 
showing  that  the  blood  supply  had  been  renewed. 

Q.     How  would  you  treat  convulsions  in  a  young  child? 

A.  Convulsions  are  sometimes  caused  by  intestinal  worms ;  by  con- 
gestion at  the  base  of  the  brain ;  sometimes  by  a  congestion  of  blood 
vessels,  or  some  displacement.  ; 

Q.     Where  and  how  do  you  treat  for  eczema? 

A.  I  have  seen  cases  of  other  troubles  complicated  with  eczema  and 
the  result  of  treatment  has  been  good.  Usually  the  patient  does  not  stay  by 
the  treatment  long  enough  to  get  the  desired  results,  as  it  is  a  slow 
process.  The  point  is  to  build  up  the  blood  and  purify  it  by  treating  all 
the  avenues  of  excretion,  and  in  that  way  remove  the  poison  from  the 
blood. 

Q.  Shell  fish  being  eaten,  hives  appear  on  the  skin  (as  a  result  of 
the  food),  and  too  long  a  time  having  elapsed  to  expel  the  food  by 
vomiting,  how  could  you  treat  this  case  to  overcome  the  conditions  where 
you  could  not  expel  the  food  at  once? 

A-  If  it  was  so  that  I  could  not  cause  vomiting,  I  would  stimulate  the 
bowels  by  the  method  already  indicated. 

Q.  Please  explain  how  glasses  seem  to  give  temporary  relief  when 
taken  off  for  possibly  five  minutes? 

A.  I  would  conclude  that  the  patient  was  growing  away  from  the 
glasses.  I  would  consult  an  oculist. 

Q.  Would  you  suggest  any  other  treatment  for  measles  other  than 
keeping  the  bowels  open? 

A.     Stimulate  the  lungs,  because  the  poison  seems  to  take  root  in  them. 

Q.     How  do  you  slow  the  heart's  action? 

A.  By  inhibition  in  the  superior  cervical  region,  and  by  raising  the 
upper  left  ribs,  and  holding  behind  the  shoulder. 

Q.     Please  explain  in  detail  the  treatment  for  sea  sickness. 

A.  Inhibition  of  the  pneumogastric  by  thrusting  the  thumb  into  the 
third  intercostal  space  on  the  left  side.  This  treatment  is  also  applied  in 
the  third  and  fourth  intercostal  spaces  upon  the  right  side,  and  in  the 
fourth  intercostal  space  upon  the  left  side;  to  this  I  would  add  inhibition 
of  the  solar  plexus  by  putting  a  pressure  upon  it,  and  stimulation  of  the 
pneumogastric  nerves. 

Q.     What  is  the  treatment  for  locomotor  ataxia  ? 


222  QUESTIONS. 

A.  A  thorough  spinal  treatment.  This  is  a  disease  of  the  spinal  cord. 
Stimulate  the  flow  of  blood  to  the  cord  from  one  end  of  the  spine  to  the 
other.  Give  attention  to  the  local  symptoms  according  to  their  nature,  e.  g., 
for  diarrhoea,  constipation,  loss  of  control  of  bladder  or  bowels,  give  the 
usual  indicated  treatment,  with  stretching  of  the  lower  limbs. 

Q.     How  do  you  treat  insomnia? 

A.  Stimulate  along  the  spine  to  increase  the  circulation :  treatment  in 
the  neck ;  thoroughly  relax  the  muscles  of  the  neck,  reducing  an}'  disloca- 
tion or  slip  between  the  vertebrae,  and  finally,  inhibition  of  the  superior 
cervical  ganglia. 

Q.     How  would  you  treat  a  child  troubled  with  worms? 

A.  Through  stimulation  of  the  liver,  causing  an  increased  secretion  of 
bile  sufficient  to  expel  such  parasites.  The  stomach  and  intestines  should 
be  stimulated  as  well,  and  the  child  should  avoid  eating  sweets. 

Q.     What  do  you  inhibit  in  the  neck  for  cutaneous  circulation  ? 

A.  The  inhibition  of  the  superior  cervical  ganglion  gets  its  effect 
upon  the  circulation  in  two  ways:  ist — through  connection  with  the 
sympathetic  directly,  and  second  through  its  connection  with  the  medulla 
by  way  of  the  sympathetic :  the  treatment,  therefore,  in  this  region  influ- 
ences the  general  circulation  to  the  body  in  that  it  affects  the  vaso-motor 
center  in  the  medulla. 

Q.  In  what  respect  would  a  general  treatment  be  compared  in  its 
general  effects  to  a  specialized  or  local  treatment  of  a  lesion  ? 

A.  A  very  general  question.  A  general  treatment  would  be  to  affect 
the  general  circulation  and  the  general  condition  of  the  nerves :  a  local 
treatment,  correctly  speaking,  ought  to  affect  the  circulation  of  the  affected 
part  under  treatment.  This  only  in  the  most  general  terms. 

Q.  Would  not  the  tendency  be  to  secure  better  results  for  a  specialized 
treatment  of  the  lesion  in  that  a  supply  of  blood  would  be  drawn  to  that 
particular  point  alone  and  thus  be  better  than  the  diffused  state  in  the  gen- 
eral treatment? 

A.  In  general.  I  would  say  the  more  specific  your  treatment  is,  the 
more  directed  to  the  locus  .of  the  lesion,  the  better.  The  tendency  of 
giving  a  general  treatment  is  far  too  great  already.  General  treatments 
should  be  judiciously  employed  as  an  adjunct  to  special  treatment  rather 
than  as  a  hit  and  miss  plan  to  affect  the  lesions. 

Q.     How  do  you  treat  for  cold  feet? 

A.  Stretch  the  limbs  by  flexing  the  knee  against  the  thorax,  and  by 
rotation  inward  and  outward,  thus  relaxing  the  muscles  and  correcting  the 
blood  supply.  Also  through  stimulation  of  the  lumbar  and  sacral  regions. 

Q.     How  can  the  bowels  be  moved  quickly. 

A.  I  should  try  a  strong  stimulation  of  the  liver.  In  obstinate  cases 
of  constipation  we  frequently  use  the  anema  first. 


QUESTIONS.  223 

Q.  Where  you  have  high  fever  caused  by  absorption  of  poisons  in  the 
blood,  what  should  be  the  treatment  ? 

A.  Stimulate  the  kidneys  and  bowels  and  lungs,  also  cutaneous  cir- 
culation; induce  copious  sweats,  thus  throwing  off  the  poisons  from  tile- 
system  ;  and  work  as  already  indicated  to  reduce  the  fever. 

Q.  What  is  the  best  plan  to  set  lateral  dislocation  at  the  first  and 
second  dorsal. 

A.  I  work  as  follows:  I  set  the  patient  upon  a  stool  with  his  back 
toward  me,  and  use  the  head  and  neck  as  a  sort  of  lever,  so  to  speak, 
placing  the  thumb  of  one  hand  upon  the  side  of  the  spine  of  the  vertebra 
on  the  side  toward  which  it  has  deviated ;  the  other  hand  being  upon  the 
back  of  the  head.  I  now  bend  the  head  down  away  from  the  vertebra  in 
question,  thus  exaggerating  the  defect,  pushing  strongly  down  to  the  side, 
meantime  pressing  with  the  thumb  upon  the  spine  of  the  dislocated  verte- 
bra in  a  direction  toward  that  from  which  it  has  come.  The  head  is  next 
pushed  around  to  the  affected  side,  thus  relaxing  the  ligaments,  while  the 
vertebra  is  firmly  forced  back,  into  place. 

Q.     Can  parasites   be  removed  by  Osteopathic  treatment  ? 

A.  The  treatment  has  already  been  indicated,  in  part ;  I  would  add 
treatment  of  the  liver,  strongly  stimulating  the  flow  of  bile ;  this  Dr.  Still 
says  is  sufficient  to  remove  intestinal  parasites. 

Q.     How  would  you  treat  a  case  of  tooth  ache  ? 

A.  Send  patient  to  the  dentist.  We  have  in  a  few  cases  had  good  re- 
sults by  inhibition  of  the  fifth  nerve,  reaching  it  in  ways  already  indicated 
in  the  course  of  these  lectures. 

Q.     Is  it  dangerous  to  reduce  bacterial   fever? 

A.  The  theory  that  it  requires  heat  to  destroy  them  would  indicate  as 
much.  In  general  I  would  say  it  is  our  practice  to  reduce  such  fevers. 
While  perhaps  the  high  temperature  of  the  body  might  tend  to  render  the 
bacteria  less  productive  of  evil  results,  yet  further  treatment  which  we 
employ  in  such  cases  would  seem  to  make  it  safe  to  reduce  the  fever  as  we 
always  do.  We  never  omit  in  such  a  case  to  strongly  stimulate  the  action 
of  the  bowels,  kidneys  and  lungs,  to  throw  off  both  the  bacteria  and  their 
products.  This  treatment,  coupled  with  the  general  spinal  treatment,  tends 
to  promote  healthy  metabolism,  thus  building  up  the  tissues  of  the  body, 
blood  included,  and  to  render  it  less  liable  to  the  growth  of  bacteria.  In 
other  words  the  theory  of  bacterial  origin  is  that  there  is  a  so-called  nidus, 
or  "nest,"  in  the  tissue  in  which  the  bacteria  may  grow.  It  is  held  by  emi- 
nent authorities  that  bacteria  will  not  grow  in  healthy  tissue,  hence  if  the 
nidus  exists  in  unhealthy  tissue,  the  work  of  the  Osteopath  in  building  up 
the  tissues  does  away  with  the  nidus,  the  ever  present  tendency  being  to- 
ward the  normal,  aiding  in  such  a  way  as  to  cause  the  tissue  at  this  par- 


224  QUESTIONS. 

ticular  locality  to  become  healthy.  Thus  the  nidus  is  destroyed,  and  the 
poor  bacterium  is  left  without  a  home.  In  regard  to  the  germ  theory,  and 
in  its  relation  to  Osteopathy,  I  might  say  that  while  the  Osteopath  accepts 
such  theory  in  general,  he,  remembering  the  fact  that  unhealthy  tissue  only 
can  form  a  nidus,  esteems  it  conclusive  that  there  must  have  been  a  cause 
for  the  previous  presence  of  the  bacteria  there,  or  there  would  not  have 
been  a  nidus.  He  simply  sees  that  the  bacteria  may  become  secondary 
causes  of  disease.  Here  his  treatment  is  devoted  to  removing  the  primary 
cause,  preventing  the  bacteria  from  gaining  a  foot-hold  in  the  body. 


Principles  of  Osteopathy. 


LECTURE  I. 

SPINAL  CURVATURES. 

The  Osteopath  meets  with  many  cases  of  spinal  curvature  in  his  daily 
practice,  no  matter  where  he  may  be  located.  It  is  a  common  and  much 
dreaded  disease.  The  Osteopath  gets  many  cases  to  treat  because  he  is  the 
"bone-doctor,"  and  people  are  quicker  to  come  to  him  with  such  com- 
plaints, or,  it  may  be,  the  failures  of  the  usual  modes  of  treatment  adopted 
by  the  medical  profession  leave  ma.ny  cases  for  the  Osteopath.  He  is  suc- 
cessful in  a  fair  number  of  cases,  but  finds  many  of  too  long  standing  to 
be  cured  by  him,  though  he  almost  invariably  benefits  them.  In  curable 
cases,  his  success  is  flattering,  presenting  the  most  complete  cures. 

Of  these,  lateral,  and  simple  posterior  curvatures  are  most  easily 
cured. 

The  importance  of  the  spine  has  been  noted.  It  might  be  called  the 
foundation  of  the  skeleton,  since  it  supports  all  the  important  parts  of  the 
body,  perhaps  on  the  whole,  more  than  do  the  limbs.  It  gets  but  little  rest ; 
e.  g.  any  one  with  a  troublesome  "backache"  finds  the  spine  very  much  in 
evidence;  at  times  neither  sitting,  standing  nor  lying,  in  any  position  will 
relieve  the  pain  of  the  ache.  Osteopaths  should  be  careful  of  their  own. 

To  fulfill  its  functions,  the  spinal  column  must  be  at  once  strong  and 
flexible,  and  the  wonderful  device  by  which  this  object  is  accomplished  is 
worked  out  by  means  of  an  intricate  arrangement  of  bones,  ligaments  and 
cartilages,  muscles,  blood-vessels  and  nerves,  each  of  which  seems  liable  to 
its  particular  disability.  The  cancellous  bodies  of  the  vertebrae  are  liable 
to  caries  and  necrosis ;  the  intervertebral  discs  to  ulceration.  suppuration 
and  changes  of  form  from  pressure ;  the  ligaments  to  strains  and  rheumatic 
affections ;  the  muscles  to  paralysis  and  spasms ;  and  the  blood-vessels  and 
nerves,  in  this  situation,  to  compression  and  abridgment  of  function. 


228  POTT'S  DISEASE. 

Hence  it  is  that  to  the  Osteopath  the  spine  becomes  the  foundation  in  a 
different  and  very  important  sense ;  and  he  regards  the  condition  of  the 
spine,  rightly,  as  experience  proves,  to  be  the  foundation  of  health  or 
disease. 

The  fact  of  the  compressibility  of  the  intervertebral  discs  is  one  of 
great  importance: 

1.  The  whole  spine  becomes  "settled"  down  together,  rigid,  smooth, 
interfering  with  general  nerve  connections ;  causing  nervous  and  special 
organic  diseases,  and  functional  troubles. 

2.  Any  single  or  several  discs  may  be  altered  in  shape  by  pressure, 
e.  g.,  altering  spinal  equilibrium  and  interfering  with  important  nerves  or 
centers. 

3.  Discs  may  be  ulcerated  and  eaten  away,  leading  to  ankylosis  and 
permanent  injury  of  the  joint. 

4.  The  most  important  part  of  spinal  treatment  is  to  separate  verte- 
brae and  allow  discs  free  blood  supply  and  room  for  growth.     Treatment 
by  suspension  accomplishes  this,  as  does  also  traction  of  the  spine,  de- 
scribed to  you  as  a  "straight  pull." 

Question  of  slight  vs.  extensive  change  in  form  of  spine,  with  vast 
difference  in  effects :  i.  Latter  is  gradual  and  parts  become  accommodated 
to  changed  shape  of  spine.  2.  Former  more  severe  and  accompanied  by 
acute  pathological  state  of  tissues.  Question  hard  to  answer,  e.  g.  Hunch- 
back and  good  general  health  vs.  slight  slip. 

Several  kinds  of  spinal  curvature  are  described :  I.  Pott's  disease 
(Posterior  angular  curvature).  2.  Scoliosis  (Lateral  curvature).  3. 
Kyphosis  (Post,  round  shoulders).  4.  Lordosis,  Anterior  curvature 
(Ant.  in  lumbar).  5.  Spastic  (Spasms  of  muscles).  6.  Hysterical. 

POTT'S  DISEASE  (Percival  Pott),  an  inflammation  of  the  spine,  char- 
acterized by  destruction  of  the  cancellous  bodies  of  the  vertebrae  and  inter- 
vertebral  discs,  leaving  the  front  parts  of  the  vertebrae  to  settle  together 
and  produce  posterior  angular  projection;  it  is  called  also  tuberculosis  of 
spine,  caries  or  osteitis  of  spine,  posterior  angular  curvature,  antero- 
posterior  curvature,  spondylitis,  etc. 

The  ulceration  and  destruction  of  the  bodies  and  intervertebral  discs 
may  be  partial  or  complete;  the  process  may  begin  in  either  structure,  and 
it  usually  terminates  in  ankylosis  of  the  affected  joints.  Usually  the  dis- 
ease begins  in  ulceration  of  the  cartilage,  and  the  adjacent  surfaces  of  the 
vertebrae  suffer  from  caries  and  necrosis.  When  the  bodies  of  the  vertebrae 
are  the  first  to  be  attacked,  they  suffer  from  primiary  necrosis,  which  seems 
particularly  liable  to  attack  cancellous  bony  structures.  The  disease 
spreads  to  involve  a  greater  or  less  amount  of  the  anterior  portion  of  the 
spine,  destroys  it,  and  causes  the  characteristic  posterior  projection.  This 
is  most  characteristic  as  angular  curvature  when  it  occurs  in  the  middle  • 


•  POTT'S  DISEASE.  229 

dorsal  region,  the  long  spines  causing  the  peculiar  angular  appearance. 
But  in  the  cervical  and  lumbar  regions  merely  an  obtuse  posterior  pro- 
jection obtains  on  account  of  the  shorter  spinous  processes  in  these 
regions.  Even  this  amount  of  curvature  may  be  absent  in  well  marked 
cases. 

Pott's  disease  is  most  usual  in  children  between  three  and  ten  years  of 
age  and  of  a  tubercular  diathesis,  but  all  ages  and  conditions  arc  subject  to 
it.  It  seems  to  be  fairly  rare. 

The  AETIOLOGY  of  this  disease  is  particularly  interesting  to  the  Osteo- 
path for  two  reasons:  I.  It  introduces  the  germ  theory.  2.  It  emphasizes 
the  importance  of  slight  mechanical  causes,  e.  g.,  blows,  wrenches,  Di- 
strains, etc.,  as  factors,  or  rather,  as  original  causes,  in  the  production  of 
disease. 

The  American  Text  Book  of  Surgery  states  that  while  slight  trau- 
matism  is  usually  the  cause  to  which  the  disease  is  ascribed,  the  tubercular 
diathesis  or  soil  is  essential  to  the  production  of  the  typical  disease.  Quain, 
however,  lays  more  stress  upon  violence  as  the  cause,  and  states  that  fre- 
quently cases  are  met  with  whose  family  history  is  free  from  scrofula,  and 
Farnum,  in  a  text  of  April,  '98,  says  that  the  microscope  fails  to  reveal  the 
tubercle  baccilli  in  but  a  few  cases.  Thus  the  doctors  disagree.  Cases  are 
frequent  in  children  after  diseases  such  as  whooping  cough,  measles  and 
scarlet  fever,  in  which  the  constitution  is  weakened.  In  the  adult,  syphilis 
and  rheumatism  predispose  to  the  disease,  as  they  affect  the  joints. 

The  direct  cause  seems  to  be  generally  some  violence.  Quain,  speaking 
of  cases  in  children  of  good  family  history  who  had  never  had  any  sickness, 
says :  "In  such  cases  we  can  hardly  doubt  that  some  slight  accident  met 
with  in  boisterous  play,  must  have  been  the  immediate  cause  of  the  disease ; 
and  in  some  instances  the  writer  has  obtained  undoubted  evidence  of  this 
fact."  He  also  mentions  such  a  cause  as  the  strain  upon  the  spine  occa- 
sioned by  a  man,  in  sport,  catching  a  child  by  the  arms,  and  swinging  him 
around  upon  his  back.  The  violence  of  course  may  'be  direct  and  severe, 
as  in  bad  falls  and  blows.  The  Osteopath  continually  emphasizes  the  im- 
portance of  such  injuries  as  causes  of  disease,  through  the  effect  they  have 
upon  the  spine,  not  so  often  in  producing  curvatures,  but  in  producing  un- 
natural conditions  in  the  spine,  which  interfere  with  nerve  force  and  cause 
various  diseases.  What  others  forget  he  strives  to  remember,  and  fre- 
quently is  sure  that  some  old  injury,  either  unnoticed  or  long  forgotten,  is 
the  source  of  present  ill.  Frequently  the  patient  will  recall  such  causes. 

AETIOLOGY: — Constitutional — e.  g.,  syphilis,  rheumatism,  scarlet 
fever,  measles,  whooping  cough,  etc.,  tuberculosis,  scrofula;  External — 
local  violence,  dirct  or  indirct. 

PATHOLOGY: — Caries  and  necrosis,  ulceration  of  discs  and  forma- 
tion of  the  angle  have  already  been  noted.  Further  consideration  of  the 


230  POTT'S  DISEASE. 

pathology  raises  additional  points  of  significance  to  the  Osteopath.  The 
inflammation  of  the  parts  may  effect  the  cord  itself  (myelitis),  causing 
paralysis  which  varies  according  to  the  region  of  the  cord  affected.  Or, 
the  inflammation  may  cause  what  is  known  as  inflammatory  pachymengitis, 
i.  e.,  a  thickening  of  the  fibrous  tissues  between  the  dura-mater  and  the 
walls  of  the  spinal  canal.  Their  growth  may  occur  only  along  the  anterior, 
pressing  upon  the  anterior  part  of  the  cord  and  the  motor  nerve  roots, 
causing  motor  paralysis.  This  is  the  most  usual  condition,  but  the  growth 
of  tissues  may  affect  both  anterior  and  posterior  parts  of  the  cord,  causing 
both  motor  and  sensory  paralysis.  Sequestra  are  formed  (portions  of  the 
bone  eaten  off  and  surrounded  by  fibrous  coat),  or  deposits  occur  and 
bring  pressure  upon  the  cord.  The  same  may  be  caused  by  the  dislodged 
vertebrae,  or  by  narrowing  or  obliteration  of  the  canal.  These  causes,  of 
course,  irritate  the  nervous  mechanism,  and  pervert  or  suspend  its  opera- 
tions, e:  g.,  the  irritation  may  be  upon  a  certain  center,  be  transmitted  from 
cord  to  sympathetics  and  affect  any  important  organ  or  organs  in  their  vital 
operations.  These  are  the  reasons  for  the  great  pain  and  distress  and  the 
very  bad  general  health  noted  in  a  patient  with  Pott's  disease. 

Just  so  the  Osteopath  in  any  ordinary  case  lays  great  stress  upon  any 
strain  or  injury  to  the  spine.  I.  Strain  followed  by  inflammation  and 
thickened  tissues.  2.  Hyperaemia  affecting  centers.  3.  Slips  or  twists  of 
vertebrae  causing  direct  pressure,  or  act  as  strains.  4.  Deposits  irritating 
centers,  etc.  5.  Rheumatic  affection  of  the  joints.  All  these  affect  nerve 
mechanism,  reach  the  sympathetic  system  usually,  and  have  far  reaching 
results.  This  is  shown  in  its  worst  form  in  Pott's  disease.  The  muscular 
rigidity  seen  in  Pott's  disease  is  due  to  deep  irritation  of  the  nerves  acting 
reflexly  upon  the  muscles. 

Symptoms:  Variable,  according  to  part  of  spine  affected.  The  early 
symptoms  are  ill-defined  (first  six  to  nine  months),  making  diagnosis 
difficult,  but  the  patient  lacks  energy,  is  irritable,  not  well,  poor  vitality. 
There  is  pain  upon  motion  and  upon  percussion  of  affected  parts  of  the 
spine.  Muscular  stiffness  and  rigidity  become  prominent  on  account  of  irri- 
tation of  nerves ;  patient  makes  unconscious  efforts  to  shield  the  part  from 
pain.  The  muscular  stiffness  causes  characteristic  attitudes:  cervical,  wry- 
neck; upper  dorsal,  neck  pushes  forward,  chin  raised /and  shoulders  fixed; 
lower  dorsal,  military  attitude ;  lumbar,  lordosis,  by  contraction  of  the 
psoas  muscles.  Abscesses  following  along  the  psoas  may  contract  the  thigh 
and  cause  the  case  to  resemble  hip-joint  disease. 

While  the  chief  deformity-  of  Pott's  disease  is  spinal  curvature,  this 
feature  may  be  absent  in  cases  where  the  disease  develops  late  in  life.  A 
slight  lateral  sweep  of  the  curve  may  occur,  indicating  destruction  of  the 
lateral  portions  of  the  vertebrae.  Secondary  curves  are  formed,  e.  g., 
dorsal  kyphosis  with  lumbar  lordosis.  Quain  notes  two  points  at  which 


SPINAL   CURVATURES.  231 

may  occur  a  spurious  form  of  posterior  curvature,  i.  e.,  seventh  cervical 
and  first  dorsal  vertebrae,  also  eighth  and  ninth  dorsal  vertebrae,  naturally 
prominent  points.  This  condition  being  sometimes  exaggerated,  accom- 
panied with  pain.  This  is  not  real  curvature.  The  former  (seventh  cer- 
vical and  first  dorsal  vertebrae)  is  often  noticed  in  hysterical  girls. 

Pain  is  an  important  symptom,  being  both  local  and  distant,  being 
roused  locally  by  percussion.  Yet  the  patient  complains  but  little  of  pain 
along  the  spine,  it  usually  being  referred,  e.  g.,  in  cervical  disease  to  the 
throat,  neck  and  arms ;  in  dorsal  disease,  to  the  chest,  intercostal  and  epi- 
gastric pains,  coughing  and  palpitation  of  the  heart;  in  lumbar  disease  the 
pains  are  colicky,  the  bladder  is  irritated  and  pains  shoot  down  the  lower 
limbs.  Motion  increases  the  pain,  e.  g.,  turning,  jumping  or  pressing  down 
the  head.  This  fact  causes  the  patient  to  hold  the  spine  as  quiet  as  pos- 
sible. The  pain,  not  usually  acute,  becomes  sometimes  lancinating.  Some 
few  cases  run  a  slow  course,  it  is  said,  with  but  little  pain.  Paralysis  is  a 
frequent  symptom ;  may  affect  the  lower  limbs,  or  the  sphincters.  On  an 
average  it  lasts  from  one  to  three  years.  Peculiar  attitudes  constitute  an- 
other important  symptom.  The  patient  goes  about  supporting  himself  upon 
some  object,  e.  g.,  furniture.  If  the  disease  is  cervical  or  upper  dorsal,  he 
rests  the  chin  upon  the  elbows,  if  lower,  he  rests  the  hands  upon  the  hips, 
or  walks  about  with  body  bent  and  hands  supported  upon  the  knees,  always 
with  the  effort  to  relieve  the  affected  portion  of  the  spine  of  the  superin- 
cumbent weight  of  the  body. 

Abscesses  are  frequent.  They  occur  as  retro-pharyngeal,  dorsal, 
iliac,  lumbar,  or  psoas  abscesses,  being  the  products  of  suppuration  fol- 
lowing the  ulceration  and  destruction  of  the  parts.  The  pus  gathers  in 
the  sheaths  of  the  muscles  and  comes  to  the  surface  at  the  points  named. 
Osteopathy,  if  used  in  time,  should  prevent  their  formation  or  cause  them, 
where  small,  to  be  absorbed. 

There  are  with  Pott's  disease,  general  constitutional  disturbances, 
asthma,  heart  disease,  indigestion,  abnormal  temperature  (99°  to  ioo°F), 
fretfulness,  chills,  loss  of  appetite,  cold  extremities,  etc.  The  disease,  if 
left  to  run  its  course,  terminates  in  bony  ankylosis  of  the  affected  joints, 
and  cure,  with  permanent  deformity  as  an  essential  of  such  cure,  or  it 
ends  in  death  from  paralysis,  myelitis,  and  general  ill  health. 

Mortality  in  children  1-20;  in  adults  1-5.  Thus  the  prognosis  is  more 
favorable  in  children  than  in  adults,  and  unfavorable  in  proportion  as  the 
disease  progresses  rapidly. 


LECTURE   II. 

LATERAL  SPINAL  CURVATURE:— SCOLIOSIS.  This  is  per- 
haps the  most  common  form  of  spinal  curvature,  and  is,  fortunately  for 
the  patient,  often  cured  by  Osteopathic  treatment.  By  far  the  larger  per 


232  LATERAL   CURVATURE. 

cent,  of  the  cases  coming  under  my  supervision  have  been  lateral  curves. 
In  lateral  curvatures,  called  also  Scoliosis  and  Rotary  Lateral  Curyature, 
the  spine  describes  two  or  more  lateral  curves,  according  to  the  American 
Text  Book  of  Surgery;  other  texts  do  not  thus  imply  the  invariable  pres- 
ence of  the  secondary  curve.  I  have  seen  cases  in  which  there  was  but 
one  lateral  deviation.  The  rule,  however,  is  to  have  a  second  lateral 
curve  with  its  convexity  in  the  opposite  direction,  while  there  may  be 
three,  or  even  four,  or  five  curves,  each  compensating  the  other.  I  am 
treating  a  case  at  present  in  which  there  are  two;  there  has  been  a  third, 
but  that  has  been  straightened  out.  That  was  in  the  lumbar  region.  The 
primary  curve  was  in  the  dorsal  region.  There  was  one  up  in  the  cer- 
yical  region  as  well.  Another  case,  which  I  might  treat  as  similar,  was 
one  iu  which  there  was  a  very  bad  curve  in  the  neck,  followed  by  a  very 
marked  lateral  curvature  between  the  shoulders. 

Practice  of  Osteopathy:  Idea  of  Compensation: — Curvatures  caused 
by  tilting  of  pelvis  or  dislocation  of  hip.  I  believe  I  spoke  of  this  mat- 
ter of  compensation  the  other  day.  That  is,  nature  is  undertaking  to  re- 
store the  equilibrium  of  the  body  which  is  lost  by  the  formation  of  one 
lateral  curve,  and  this  may  be  further  carried  out  in  the  pelvis  or  in  dis- 
location of  the  hip.  I  had  a  case  of  dislocation  of  the  hip  on  the  left  side 
which  had  been  followed  by  lateral  curvature  in  the  lumbar  region  to- 
ward the  right,  making  a  sort  of  compensation  in  that  way.  Again,  I 
had  a  case  in  which  there  was  wry-neck.  The  neck  bent  to  one  side  and 
even  that  seemed  to  change  the  equilibrium,  throwing  the  weight  on  the 
opposite  side  on  the  sacro-iliac  ligaments.  You  see  how  badly  such  a 
casue  may  affect  equilibrium  of  the  spine  which  is  so  delicate,  and  thus 
cause  a  change  in  the  parts  to  meet  the  new  conditions. 

Lateral  curvature  is  said  to  be  more  frequent  in  girls  than  in  boys, 
and  frequently  it  is  so  slight  as  to  be  unnoticed  until  discovered  by  acci- 
dent. I  had  a  case  not  long  ago  in  which  there  was  a  marked  lateral 
curvature  to  the  left,  taking  in  most  of  the  spine  from  the  cervical  region 
down.  They  told  me  that  they  had  not  noticed  the  curvature  coming  on 
until  it  was  pronounced,  and  you  will  find  that  so  in  quite  a  number  of 
cases. 

Aetiology: — The  causes  of  the  disease  may  be  local,  e.  g.,  faulty 
position;  constitutional,  e.  g.,  ricketts;  or  both.  The  most  usual  cause 
seems  to  be  weakness,  the  spinal  muscles  giving  way  more  on  one  side 
than  on  the  other,  allowing  the  spine  to  sag.  Such  weakness  is  often 
apparent  as  the  result  of  rapid  growth  or  of  sickness."  Dr.  Harry  Still 
had  a  case  in  which  the  patient  had  a  very  tender  spine,  and  we  found 
after  we  had  been  treating  him  for  some  time  that  he  had  a  slight  curva- 
ture. These  things  arise  sometimes  without  apparent  cause.  For  in- 
stance, I  knew  a  young  man  in  splendid  health  who  had  a  marked  lateral 


LATERAL   CURVATURE.  233 

curvature.  He  had  had  no  bad  accident  or  apparent  cause.  It  seemed  in 
his  case  to  be  simply  due  to  very  rapid  growth.  He  was  over  six  feet 
tall.  It  seems  that  the  system  is  not  always  able  to  stand  the  strain  put 
upon  it  by  rapid  growth.  I  had  another  case  exactly  similar. 

A  habitual  faulty  position,  as  in  sitting  at  a  desk,  or  holding  an 
infant  always  on  one  arm,  will  frequently  cause  it.  Carrying  a  heavy 
weight,  as  school  books,  or  a  heavy  child,  may  become  a  cause.  I  knew 
of  a  young  lady  who  carried  her  heavy  infant  brother  about.  Without 
doubt  this  was  the  cause  of  her  trouble. 

Obliquity  of  the  Pelvis: — I  noted  a  case  of  a  young  girl  with  the  left 
hip  dislocated  upward,  the  curvature  of  the  spine  taking  place  with  the 
convexity  toward  the  right  in  the  lumbar  region,  as  a  compensation.  As 
far  as  I  was  able  to  learn  the  curvature  was  caused  in  this  way,  as  the 
mother  did  not  know  that  it  had  occurred  until  I  pointed  it  out.  Unilat- 
eral muscular  atrophy,  or  hypertrophy,  or  muscular  spasms  from  a  cen- 
tral cause  will  all  act  as  causes  of  lateral  curvature.  A  rickety  condition 
will  also  weaken  the  spine  and  cause  this  curvature,  as  will  empyema, 
through  muscular  fixation  of  the  affected  side.  I  have  known  several 
cases  in  which  the  curvature  came  on  without  apparent  cause,  previous 
illness,  or  anything  of  that  kind.  I  noted  the  other  day  a  case  of  a  young 
man  who  developed  lateral  curvature  and  had.  following  that,  locomotor 
ataxia.  His  case  came  on  without  apparent  cause.  Quain  assigns  hered- 
ity as  a  predisposing  cause. 

ANATOMICAL  CHARACTERS:— The  spine  does  not  simply  yield 
laterally,  but  the  bodies  of  the  vertebra?  turn  so  that  the  anterior  aspect  of 
the  body  of  the  vertebra  comes  to  look  laterally  in  the  center  of  the 
curvature,  having  described  the  quadrant  of  circle.  The  transverse  pro- 
cesses project  anteriorly  and  posteriorly:  the  spinous  processes,  laterally. 
The  bodies  turn  outward  so  as  always  to  be  upon  the  convexity  of  the 
curvature.  The  transverse  processes  are  anterior  and  posterior,  the 
spinous  process  is  laterally  in  the  opposite  direction  from  the  body  of  the 
vertebra.  You  see  that  you  have  a  great  change  in  the  condition  of  the 
spine.  The  discs,  as  well  as  the  bones,  become  ea'en  away.  You  have  a 
condition  of  changed  form  of  bone,  ligaments  and  muscle?.  I  think  that 
this  will  well  illustrate  to  you  what  we  have  to  deal  with  in  case  of  lateral 
curvature.  The  relations  of  the  ribs  are  changed,  bulging  backward  at 
their  angles  on  the  convex  side,  carried  forward  on  the  opposite  side. 
and  making  a  deep  depression  along  the  concavity  of  the  spine.  On  the 
convex  side  the  ribs  become  much  more  oblique  than  before:  on  the  con- 
cave side,  more,  horizontal  and  wider  apart.  The  bodies  always  deviate 
more  than  the  spinous  processes,  and  thus  you  see  that  you  have  a  con- 
dition that  is  not  fully  indicated  by  the  alignment  of  the  spinous  pre- 


234  LATERAL   CURVATURE. 

cesses,  so  do  not  be  misled.     Quain  does  not  consider  the  deviation  of  the 
spines  any  sign  of  a  curvature. 

PATHOLOGY: — The  bones,  ligaments,  muscles  and  vertebrae  all 
undergo  a  pathological  change  during  the  course  of  the  disease,  accom- 
modating themselves  to  the  new  formation  of  the  parts.  The  interverte- 
bral  cartilages  become  compressed  on  one  side  by  the  unequal  pressure, 
and  assume  a  wedge  shape,  the  thin  edge  of  the  wedge  being  toward  the 
concave  side.  Pressure  and  absorption  also  gradually  alter  the  shape  of 
the  vertebrae  and  of  their  articular  processes.  You  readily  see  what  a 
strain  comes  upon  these  processes,  and  the  facets  gradually  wear  away, 
facing  another  direction,  instead  of  back  and  up.  So  you  see  how  ex- 
tensive the  change  is.  The  vertebrae  become  more  or  less  wedge  shaped, 
while  the  direction  of  the  faces  of  the  articular  processes  become  changed. 
These  structural  changes  confirm  the  condition  of  the  curvature  and  make 
it  more  difficult  to  cure.  If  a  man  comes  to  you  and  wants  to  know 
how  soon  you  can  cure  a  lateral  curvature,  you  will  have  to  tell  him  that 
the  case  is  such  that  you  will  have  to  alter  even  the  shape  of  the  bones  be- 
fore you  can  effect  a  cure. 

Late  authorities  describe  the  muscles  and  ligaments  as  relaxed  and 
atrophied  on  the  convex  side,  and  contracted  and  strengthened  on  the 
concave  side.  Quain  disagrees  with  this,  stating  that  the  muscles  are 
simply  displaced  on  the  concave  side,  pushed  together  and  thus  apparently 
contracted.  You  can  readily  see  how  this  could  be.  The  -muscles  and 
ligaments  are  weakened  on  this  convex  sid'e,  and  become  atrophied  be- 
cause pushed  out  of  place,  while  these  on  the  other  side  will  become 
contracted,  because  it  is  a  rule  that  if  you  approximate  the  points  of  origin 
and  insertion  of  a  muscle  it  will  contract  to  conform  to  the  changed  posi- 
tion. Quain  says  they  are  simply  pushed  over  and  in  that  way  apparently 
contracted,  while  the  later  authorities  say  that  there  is  a  distinct  change 
of  condition  on  this  side. 

Anteriorly  the  sternum  becomes  very  oblique,  and  the  cartilages  of 
the  concave  side  bent  upon  themselves.  The  thoracic  and  abdominal 
organs  are  displaced  and!  interfered  with,  often  causing  organic  troubles. 

The  lung  on  the  concave  side  i?  compressed:  the  heart  may,  in  some 
cases,  be  displaced  to  the  right  side:  the  liver  and  stomach  and  intestines 
are  forced  downward;  while  the  kidney  and  spleen  on  the  convex  side  are 
said  to  be  usually  smaller  than  on  the  other  side.  In  cases  of  a  rachitic 
character  there  is  often  deformity  of  the  pelvis. 

Symptoms: — The  curvature  is  often  so  slow  in  development  that  it  re 
mains  unnoticed  for  a  considerable  time,  being  noticed  first  in  fitting 
clothes  by  a  dressmaker,  or  sometimes,  in  case  of  a  boy,  the  suspender 
slips  off  the  shoulder  too  easily,  or  one  scapula  is  a  little  too  prominent, 
or  some  slight  irregularity  in  the  patient's  gait  is  noticed.  One  shoulder 


HYSTERICAL   AND    POSTERIOR   CURVATURES.  235 

is  higher.  If  on  the  left  (left  deviation),  the  right  breast  and  iliac  crest 
will  be  slightly  too  prominent;  the  curve  of  the  waist  deeper  on  the  right, 
and  the  distance  from  the  right  axilla  to  the  hip  shorter.  That  is  one 
place  where  you  may  make  a  valuable  measurement.  I  would  advise  you 
always  in  these  cases  to  make  measurements.  I  have  a  case  of  very 
marked  curvature,  extremely  to  the  right;  on  the  left  side  the  hip  is  up 
so  that  the  ribs  as  high  up  as  the  sixth  or  seventh  rib  fall  down  over  the 
crest  of  the  ilium.  That  is  one  of  the  most  marked  cases  of  curvature 
that  I  have  seen,  and  was  caused  by  a  fall  from  a  swing.  Quain  states 
that  the  diagnosis  cannot  be  made  simply  upon  the  lateral  devition  of  the 
spine,  since  this  often  occurs  in  weakness  or  in  hysterical  conditions.  The 
diagnosis  must  rest  upon  the  torsion  of  the  vertebrae  and  changed  direc- 
tion of  the  transverse  processes. 

Symptoms  of  nervousness,  palpitation  of  the  heart,  shortness  of 
breath,  indigestion,  etc.,  are  often  present,  as  are  also  indisposition  to 
exercise,  vague  feelings  of  discomfort,  and  pain  and  tenderness  in  the 
back. 

Suspension  will  cause  the  curve  to  disappear  in  mild  and  short  time 
cases.  Those  which  d'o  not  thus  disappear  have  become  strongly  fixed. 
If  the  curve  persists  until  maturity,  it  as  a  rule  remains  throughout  life. 
Osteopathic  experience  is  contrary  to  this.  I  might  say  that  cases  of 
people  well  advanced  in  life  have  been  rendered  fairly  straight,  although 
it  seems  that  maturity  has  limited  our  practice  somewhat  in  that  respect. 
It  is  also  stated  that  the  prognosis  is  unfavorable  in  proportion  to  the 
youth  of  the  subject  when  the  curve  begins.  Here  also  Osteopathic  ex- 
perience is  at  variance  with  the  authorities. 

,  A  double  curvature  is  likely  to  t>e  self-limited,  by  the  arms  of  the 
"S"  reaching  equality  and  establishing  an  even  balance.  Thus,  if  you 
have  a  curvature  occurring  first  in  the  upper  dorsal  or  in  the  cervical, 
you  are  liable  to  have  a  curvature  on  the  other  side  lower  down,  since 
nature  has  to  restore  the  equilibrium.  Thus  a  curvature  is  apt  to  be  self 
limited,  not  self  cured,  but  more  curves  may  appear,  as  you  already  see. 
The  long  single  curve  is  apt  to  lead  to  the  greatest  deformity.  The  great 
majority  of  cases  reach  a  certain  stage,  become  stationary,  and  pass 
through  life  with  slight  deformity  and  but  Ijttle  trouble  from  the  curva- 
ture. In  some  cases,  however,  progressive  deformity  leads  to  immense 
distortion. 

HYSTERICAL  CURVATURE  :— A  form  of  curvature  described  as  a  lateral 
curvature  which  may  be  made  to  disappear  by  causing  the  patient  to  bend 
forward  until  the  tips  of  the  fingers  touch  the  ground. 

KYPHOSIS,  or  posterior  curvature,  is  a  term  used  to  describe  the  com- 
mon condition  of  round  shoulders,  as  is  usually  found  in  the  upper  dorsal 
region.  The  same  term,  however,  is  descriptive  of  ordinary  posterior 


236  POSTERIOR   CURVATURE. 

curvature  of  any  portion  of  the  spine,  but  not  of  Pott's  disease,  com- 
monly, though  sometimes  used  as  a  synonym  for  that  term.  Its  causes 
seem  to  be,  in  general,  these  which  have  been  described,  for  lateral  curva- 
ture, viz.:  faulty  position,  weakness  and  debility,  paralysis,  ricketts,  etc. 
For  example,  it  is  found  in  infants  who  have  been  allowed  to  sit  up  too 
much;  in  growing  girls  who  sit  in  bad  positions  at  school  or  at  the 
piano;  in  professional  men  who  bend  over  desks;  or  in  bicycle  riders 
who  assume  an  extreme  position.  Old  age  and  debility  weaken  the 
muscles  of  the  back,  and  allow  the  spine  to  bend.  Years  of  hard  work, 
e.  g.,  as  in  miners,  shoemakers,  etc.,  is  also  a  cause.  Sometimes  it  is 
the  result  of  positions  assumed  to  ease  pain,  as  in  asthma,  metritis  and 
rheumatism. 

Pathology: — The  chief  features  are  a  relaxation  of  the  spinal  liga- 
ments at  the  spot  affected,  allowing  a  protrusion  of  the  spinous  processes, 
and  a  separation  from  each  other;  an  approximation  of  the  bodies 
anteriorly,  resulting  in  destruction  of  the  edges  of  the  intervertebral 
discs  and  of  the  bodies  of  the  vertebras  from  pressure  atrophy.  In  old 
age,  ossification  of  the  joints  may  have  occurred.  The  stature  is  dimin- 
ished. It  must  be  distinguished  from  Pott's  disease  by  the  rounded, 
instead  of  the  angular  curvature;  by  the  absence  of  muscular  rigidity, 
tenderness,  pain  arid  symptoms  of  involvment  of  the  cord. 

It  is  stated  that  infants  usually  recover  from  the  disease  spontan- 
eously; children  generally  recover  upon  exercise.  If  present  at  maturity 
it  remains  during  life,  but  amounts  to  but  small  deformity  in  the  adult. 
If  occuring  late  in  life  it  is  apt  to  be  progressive. 

LORDOSIS,  or  anterior  curvature,  is  rather  rare.  It  is  usually  in  the 
lumbar  or  in  the  dorso-lumbar  region,  often  being  the  secondary  curva- 
ture in  Pott's  disease.  In  this  affection  the  hips  are  prominent  behind, 
and  the  pubes  is  depressed,  showing  a,  tilting  of  the  pelvis.  The  causes 
are  commonly,  weakness  of  the  muscles  and  ligaments  of  the  lower  por- 
tion, of  the  spine,  as  in  ricketts  and  paralysis.  Great  weight  of  the 
abdomen,  .as  in  ascites  or  pregnancy,  and  in  persons  with  a  naturally 
large  or  fatty  abdomen,  seems  to  be  the  cause  of  the  trouble.  It  is  met 
in  certain  diseases  of  the  hip  in  which  the  joints  are  partly  flexed. 
Structural  changes  occur  in  the  nature  of  relaxed  and  lengthened  anterior 
muscles  and  ligaments,  the  reverse  being  true  of  these  posterior  struc- 
tures. Also  there  is  a  change  of  form  in  the  vertebra;  and  intervertebral 
discs.  They  become  wedge  shaped  by  pressure  atrophy,  with  their  thin 
edges  backward.  After  maturity  the  deformity  is  apt  to  become  per- 
manent, but  in  many  cases  disappears  in  a  few  months. 


TREATMENT  OF  SPINAL  CURVATURES.  237 


LECTURE  III. 

To-day  I  wish  to  illustrate  the  TREATMENT  OF  SPINAL  CURVATURES.  In 
treatment  of  spinal  curvature  we  should  consider  first  the  theory,  and 
second  the  practice.  The  description  of  theory  might  be  divided  into 
first,  the  mechanical  work  purely.  We  have,  to  do  a  certain  amount  of 
mechanical  work  upon  the  spine.  Parts  are  out  of  place  and  just  as  you 
would  pile  up  a  pile  of  'blocks  that  have  been  knocked  over,  it  is  a 
mechanical  matter  to  readjust  all  of  the  parts  which  are  out  of  place. 
That  part  of  our  work  is  purely  and  simply  mechanical.  You  might  pile 
up  a  pile  of  lumber,  but  if  you  want  to  be  sure  of  its  remaining 
so,  you  will  have  to  put  supports  about  it,  hence  we  will  have  to  do 
something  more  than  simply  put  parts  back  mechanically.  The  muscles 
and  ligaments  must  be  strengthened  and  stimulated  to  hold  them  in 
place.  Since  the  muscles,  ligaments  and  vertebrae  are  affected  by  bloud 
and  nerve  supply,  these  parts  in  the  normal  spine  are  retained  in  position 
by  free  and  unobstructed  supply  of  blood. 

We  retain  these  parts  in  place  by  strengthening  and  stimulating  the 
nerve  and  blood  supply  so  that  the  ligaments,  muscles,  etc.,  :-re  kept  in 
proper  condition. 

First,  then,  as  to  the  mechanical  work.  Its  purpose,  as  already 
indicated,  is  to  return  parts  to  place,  but  we  cannot  separate  these 
methods  of  treatment,  the  strengthening  and  stimulating  must  be  used 
together  with  the  replacing  of  parts.  Not  only  are  the  vertebrae  out  of 
place,  but  they  are  changed  in  form,  they  have  become  flattened  on  one 
side.  It  is  going  to  be  a  difficult  matter  to  hold  them  in  place.  You 
must  take  that  into  consideration  in  building  up  the  spine.  These  parts 
slipped  back  mechanically  are  not  going  to  stay,  the  first,  second  or  not 
even  the  third  time.  You  will  have  to  keep  at  work  on  them,  return 
them  to  place,  and  keep  strengthening  the  ligaments  in  order  that  they 
may  be  held  in  place.  How  can  you  shape  the  material  so  that  it  will 
stand  in  this  delicate  column?  That  question  we  have  to  deal  with  in 
any  spinal  curvature.  A  word  as  to  theory.  We  must  build  up  and 
restore  lost  parts.  Tension  or  suspension  as  you  may  readily  see,  tends 
to  the  alignment  of  the  vertebrae.  You  know  how  we  get  this  effect  upon 
the.  spine.  You  can  have  some  one  holding  the  ankles,  and  you  can 
exert  a  great  deal  of  traction  upon  the  spine,  under  ordinary  circum- 
stances, without  danger.  However,  I  have  known  cases  of  spinal  curva- 
ture where  the  patients  were  rendered  bed-ridden  by  stretching  in  this 
way,  so  you  must  be  very  careful.  You  must  judge  how  much  the  patient 
can  stand.  This  method  of  traction  is  one  of  the  best  methods  that  we 
have,  for  reasons  that  I  shall  show  you  later  as  to  the  theory;  but  you 
see  how  it  is  accomplished,  with  the  patient  lying  upon  his  back  and 


238  TREATMENT   OF   SPINAL   CURVATURES. 

with  the  "straight  pull."  It  can  also  be  done  in  this  way;  you  may  have 
the  patient  sitting  (it  is  particularly  good  for  small  children),  having  the 
hips  held  down,  and  raising  the  upper  part  of  the  body  by  reaching  over 
and  raising  the  weight  at  various  points  along  the  spine,  from  below 
upward,  thus  stretching  the  spine  all  the  way  along. 

There  is  a  method  frequently  used  'by  surgeons  in  spinal  curvatures. 
The  method  is  simple  and  readily  shown.  You  have  a  suspensory  appar- 
atus consisting  of  a  bow  of  steel  with  two  hooks  on  either  side,  and  with 
a  ring  on  the  top  to  hang  it  up  by.  From  the  inner  hooks  arc  straps 
leading  to  the  collar  which  buckles  under  the  chin.  On  the  ends  of  this 
bow  you  have  straps  descending  with  supports  for  the  arm.  There  you 
have  your  patient  suspended,  pulled  up  with  a  pulley.  His  feet  are  free 
of  the  floor  and  you  have  the  weight  of  the  body  then  all  hung  from  the 
point  of  the  greatest  curvature,  since  upon  that  point  comes  the  greatest 
traction.  That  is  one  of  the  common  methods  used  by  surgeons  in  the 
treatment  of  curvatures.  I  knew  it  used  in  one  case  by  an  Osteopath. 
It  seemed  to  be  very  good.  The  case  was  a  very  bad  lateral  curvature. 
The  stature  of  the  patient  was  increased  about  three  inches  in  a  month, 
some  studients  are  trying  this  method  now.  I,  myself,  have  not  tried  it. 

Besides  that  you  can  use  this  motion  which  I  have  already  shown 
you.  Have  the  patient  sitting  with  his  back  toward  you;  his  hands 
clasped  behind  his  neck.  You  th'en  Teach  tinder  the  axilla,  and  grasp  the* 
wrist  on  each  side,  then  you  push  the  head  forward  against  the  resistance 
of  the  patient,  and  stretch  the  spine  back  in  such  a  way  as  to  bring  tension 
along  the  spine.  I  think  that  is  a  very  good  movement.  The  tension 
that  is  exerted  in  this  way  is  one  of  our  valuable  methods  of  treating 
spinal  curvature. 

Another  way  is  to  work  from  the  spine,  springing  the  spine  toward 
the  concavity.  Where  the  spine  is  deviated  laterally  I  would  have  the 
patient  lie  upon  the  side  with  the  convexity  upward.  I  can  then  work 
against  the  convexity,  forcing  the  spine  toward  the  concavity.  The 
muscles  on  the  uppermost  side  of  the  body  are  almost  entirely  relaxed. 
I,  standing  in  front  of  the  patient,  reaching  down  upon  the  vertebrae, 
bring  pressure  upon  the  spine.  I  usually  push  the  shoulder  down 
toward  the  curvature  and  spring  the  spine.  I  find  this  method  very 
good  indeed.  You  can  work  from  above  downward,  or  from  below 
upward. 

Our  second  method,  then,  of  mechanically  working  the  spine  back 
into  place,  is  to  spring  the  spine  toward  the  concavity.  Another  way  is 
to  work  against  the  ribs.  They  being  attached  to  the  transverse  pro- 
cesses of  the  vertebrae  by  ligamentous  bands,  may  thus  be  used  by  their 
connection  to  some  extent  to  force  the  vertebrae  back  into  place.  Doctor 
Still  one  day  showed  me,  in  a  certain  case,  this  motion:  having  the 


TREATMENT   OF    SPINAL    CURVATURES  239 

patient  upon  the  side  with  the  convexity  upward,  he  reached  over  so 
that  the  thumb  of  the  left  hand  was  upon  the  angles  of  the  ribs  on  the 
lower  side  of  the  body,  the  fingers  of  the  right  hand  were  against  the 
angles  of  the  ribs  on  the  upper  side.  He  then  spread  the  ribs,  springing 
the  upper  ones,  upon  which  he  was  working  particularly,  down  and  then 
upward;  having  sprung  them  down  to  release  them  from  the  transverse 
processes  and  to  stretch  the  ligaments;  and  then  upward.  This  helps  the 
ribs  which  are  more  or  less  displaced,  and  also  helps  to  draw  the  vertebra? 
a  fixed  point. 

Another  way  is  to  have  the  patient  sitting.  This  method  is  especially 
good  in  cases  where  the  curvature  is  high  up  between  the  shoulders. 
Work  against  the  ribs  in  front.  You  can  press  with  the  knee  against  the 
anterior  ends  of  the  ribs,  and  draw  the  arm  up  in  such  a  way  as  to  bring 
tension,  thus  exerting  such  a  pressure  upon  the  transverse  processes  of 
the  vertebrae  behind  as  to  help  bring  them  back  into  place.  You  should 
be  careful  and  not  press  hard  at  the  knee,  the  ribs  being  joined  to  the 
sternum  by  cartilages  which  may  be  ruptured.  Use  the  knee  merely  as 
a  fixed  point. 

Another  motion  that  I  use;  having  the  patient  sitting  upon  a  stool,  I 
reach  under  the  arm  to  the  angles  of  the  ribs  on  either  side,  and-  then 
turn  the  patient  from  side  to  side,  lifting  the  superincumbent  weight  off 
the  vertebrae  and  springing  the  spine  back  toward  the  original  position. 
Not  only  do  I  hold  on  each  side  against  the  angles  of  the  ribs,  but  I  may. 
releasing  one  hand,  and  grasping  the  arm,  reach  over  the  spinous  pro- 
cesses, and  thus  twist  the  patient  around,  get  a  great  deal  of  force  exerted 
against  the  spinous  processes.  This  is  a  mechanical  manner  of  springing 
back  into  place  that  which  :s  misplaced.  Further,  you  may  with  the 
patient  sitting,  stand  on  the  side,  thrusting  your  hand  under  the  axilla  on 
the  opposite  side,  you  can  thus  raise  the  weight  of  the  patient's  body  to  a 
considerable  extent.  I  thrust  the  thumb  against  the  spinous  processes. 
and  working  with  this  twisting  motion,  make  the  thumb  a  fixed  point 
and  spring  the  vertebrae  back.  You  can  work  up  and  down  the  spine  in 
that  way  and  tend  to  bring  the  vertebrae  back  to  position.  You  will 
notice  a  great  difference  in  spines.  Some  are  quite  mobile,  while  others 
are  as  stiff  as  iron,  and  it  is  very  difficult  to  move  them.  Tt  depends 
upon  the  case.  Another  point  which  Doctor  Still  lays  stress  upon,  is  to 
begin  at  the  bottom  of  the  curvature  and  work  upward:  the  idea  being 
that  the  lower  vertebras  are  larger  than  those  above,  therefore  more 
stable,  and  you  can  work  better  than  from  above  downward.  This  may 
not  be  an  invariable  rule.  You  should  have  a  purpose  in  your  work 
along  the  spine.  If  every  day  you  attempt  to  replace  one  vertebra?  you 
are  working  with  a  definite  point  in  view.  Do  not  simply  work  up  and 
down  the  spine.  Fix  your  attention  upon  a  single  vertebra  each  day 


240  TREATMENT  OF  SPINAL  CURVATURES. 

and  try  to  restore  it  to  position.  Working  from  it  up  you  will  succeed 
better. 

Q.  If  there  were  several  vertebrae  out,  would  you  only  work  upon 
one  each  day? 

A.  I  would  give  these  general  treatments  described  for  the  general 
help  it  would  be,  but  I  would  direct  my  attention  particularly  to  getting 
one  back  into  position,  though  I  would  not  work  on  one  alone. 

Reduce  the  secondary  curvature  first,  because  it  is  later  in  date,  and 
as  a  rule  less  in  extent.  Therefore  it  is  more  amenable  to  your  treatment 
and  more  readily  restored.  You  will  find  that  the  secondary  curvatures 
yield  first.  Those  which  come  first,  as  a  rule  are  more  difficult  to 
restore. 

I  would  first  remove  any  appliances  which  may  have  been  put  on  in 
the  shape  of  stays,  braces,  etc.,  to  allow  free  motion,  freedom  of  exercise, 
and  the  free  flow  of  blood.  The  removal  frees  the  patient  from  the  irrita- 
tion which  these  appliances  cause.  I  do  not  say  this  simply  to  condemn 
any  other  practice,  but  it  is  our  practice  to  remove  them  to  get  the  spine 
to  depend  upon  its  own  strength.  So  much  then  for  the  purely  mechan- 
ical theory  of  our  work. 

Q.  By  putting  the  lower  vertebrae  back  into  place,  would  that  have  a 
tendency  to  throw  the  one  above  back  to  some  extent? 

A.  Yes,  sir,  as  far  as  you  could  within  limits.  The  whole  tendency 
is  to  work  the  one  above  back  with  the  lower  one.  You  cannot  work 
upon  one  of  the  vertebrae  entirely  independently  of  the  others.  That  is 
more  a  plan  of  work.  Work  with  the  intention  to  restore  first  one  and 
then  the  other. 

I  hardly  need  to  illustrate  what  I  am  about  to  say  in  regard  to 
stimulating.  You  must  thoroughly  relax  all  of  the  muscles  along  the 
spine,  having  the  patient  upon  his  face.  Stretch  the  muscles  and  stim- 
ulate them. 

Further  as  to  theory.  You  remember  I  have  spoken  of  the  central 
distribution  of  the  sympathetic  nerve  from  the  ganglia,  supplying  the 
ligaments,  the  vertebrae,  dura-mater,  bones  and  vessels.  I  mean  the 
blood  vessels  going  to  the  muscles,  cord.  etc..  and  supplying  all  of  these 
structures  that  we  work  upon.  We  are  not  simply  relaxing  muscles,  but 
we  are  acting  upon  the  sensory  peripheral  terminals  of  the  nerves,  getting 
the  effect  through  them.  The  action  upon  the  sympathetic  thus  influ- 
encing the  sympathetic  centers,  we  get  the  effect  upon  the  spinal  column. 
That  I  bring  out  as  a  point  of  theory  particularly  concerned  in  our  work 
upon  the  spinal  column.  Remember  that  the  ligaments  and  muscles  arc 
holding  the  parts  of  the  spine  in  place  and  depend  for  strength  upon 
proper  flow  of  blood  to  them,  consequently  when  you  are  working  upon 
blood  supply  your  work  is  primary. 


TREATMENT   OF   SPINAL   CURVATURES.  241 

Now  a  word  as  to  the  theory  connected  with  the  good  of  bringing 
traction  upon  vertebrae  by  a  straight  pull,  or  in  the  other  ways  shown. 
Tension  spreads  the  vertebrae  and  allows  the  free  ingress  of  the  blood  to 
the  discs  and  all  of  the  structures  concerned.  These  have  been  pressed 
out  o,f  shape..  What  you  wish  to  do  is  to  so  separate  that  the  blood  can 
be  thrown  to  the  parts.  The  effect  that  you  will  get  is  to  allow  the 
tendency  toward  the  normal  to  restore  parts  to  normal  shape  and  condi- 
tion. So  there  is  one  important  point  in  theory  as  to  why  we  bring  the 
straight  pull  upon  the  vertebrae.  Thus  the  vertebra  and  the  discs  are 
to  be  built  up.  You  will  not  have  a  straight  column  or  a  strong  spinal 
column  until  that  has  taken  place. 

The  process  of  ulceration  and  suppuration  may  be  stopped  in  Pott's 
disease,  so  that  you  may  prevent  the  posterior  angular  curvature  if  yru 
get  your  case  in  time;  prevent  the  fixation  of  the  joints.  These  remarks 
apply  to  all  the  work  of  stimulation  of  blood  supply  along  the  spine. 
We,  thus  by  all  of  these  means,  increase  blood  supply,  strengthen  mus- 
cles and  ligaments,  and  cause  them  to  hold  the  ground  regained  by 
holding  replaced  parts  in  place.  Of  course  you  cannot  always  have 
parts  stay  where  you  put  them.  It  is,  therefore,  a  process  of  growth. 
You  must  bear  in  mind  when  a  patient  comes  in  with  spinal  curvature, 
that  to  cure  it  will  take  time.  It  must  be  slow  and  natural.  This  will 
enable  you  to  explain  in  a  great  many  cases  to  patients  who  desire  a 
short  period  of  treatment  and  expect  to  be  cured. 

Spring  the  spine  both  ways.  Placing  the  patient  upon  the.  side,  I 
spring  the  spine  toward  me,  then  with  the  patient  upon  the  other  side  I 
spring  the  spine  again.  You  may  suppose  that  you  should  spring  the 
spine  only  toward  the  concavity,  but  the  theory  is  this,  that  in  springing 
toward  the  concavity,  then  springing  away,  you  get  the  effect  of  the 
recoil.  Then  you  must  pay  attention  to  the  general  health  according  to 
the  symptoms  that  you  encounter.  There  are  various  complications  of 
the  heart,  lungs  and  internal  viscera,  or  there  may  be  general  symptoms, 
and  you  must  direct  your  treatment  accordingly. 

Appropriate  exercises  are  good.  If  your  patient  has  a  curvature  in 
the  lower  dorsal  region,  anywhere  below  the  shoulders,  he  can  hang 
upon  a  horizontal  bar  by  the  arms.  It  is  a  good  exercise  for  any  one. 
We  are  always  shorter  in  the  evening  than  when  we  get  up  in  the  morn- 
ing. It  is  good'  practice,  this  and  other  appropriate  exercise,  to 
strengthen  the  general  health  and  strengthen  the  muscles  of  the  back. 
This,  of  course,  is  not  Osteopathic  practice,  but  it  is  exercise  which  is 
useful  in  aiding  you  in  your  treatment. 

I  might  say  further  that  the  lateral  curve  between  the  shoulders  is 
perhaps  the  most  difficult,  and  in  addition  to  general  stimulation  which 
we  give  the  spine  in  that  region,  by  working  the  muscles  and  springing 


242  TREATMENT   OF    SPINAL   CURVATUEES. 

it  from  side  to  side,  I  have  a  motion  which  I  think  is  very  good,  and 
which  I  illustrate  in  this  way:  The  patient  sitting  upon  the  stool,  and 
I  standing  at  the  back,  have  the  thumb  of  one  hand  pressed  against 
the  spinous  process  of  the  vertebra  on  the  side  toward  the  convexity, 
and  I  push  the  head  around  toward  the  opposite  side,  at  the  same  time 
pressing  the  thumb  upon  the  spinous  process  back  toward  the  concavity, 
and  drawing  the  head  around  away  from  the  concavity.  This  method 
I  have  found  to  be  one  of  the  best  for  reducing  curvature  between  the 
shoulders,  as  well  as  reducing  the  dislocation  of  a  single  vertebra.  I 
think  that  what  I  have  said  you  may  readily  apply  to  the  lower  dorsal 
and  lumbar  curvatures  and  secondary  curvatures  without  my  saying 
anything  more  now. 

I  will  speak  a  few  minutes  as  to  the  results.  ,  In  the  first  place,  in 
Pott's  disease,  very  many  cases  have  been  helped  where  they  have 
taken  treatment  soon  enough,  and  in  advanced  cases  you  can  do  a  great 
deal  of  good.  In  advanced  cases  I  have  been  able  to  relieve  fever  and 
nervous  symptoms-  and  general  symptoms  from  which  the  patient  was* 
suffering,  by  ordinary  work  along  the  spine.  Often  the  patient  is  very 
weak  and  you  must  be  careful  to  not  treat  strongly.  There  is  one 
patient  that  I  treat  very  little,  scarcely  any  at  all,  but  I  reduce  the  fever, 
and  the  patient  is  always  relieved. 

These  cases  if  taken  in  time,  may  be  saved  from  deformity  by  pre- 
venting an  angular  curve.  Where  the  abscesses  have  not  entirely 
formed  they  may  be  prevented,  and  the  pus  may  be  absorbed.  I  knew 
of  one  case  greatly  deformed  where  the  symptoms  were  all  relieved. 
and  the  patient  has  been  enjoying  fairly  good  health  ever  since.  If  you 
get  a  case  early,  good  results  generally  follow. 

Kyphosis,  posterior  curvature,  and  scoliosis,  lateral  curvature,  in 
favorable  cases  are  cured.  Even  where  we  have  not  been  able  to  effect 
a  cure,  we  have  been  able  to  prevent  further  progress.  We  have  been 
able  to  change  the  distorted  parts  to  normal  even  after  maturity,  but 
the  early  cases  give  the  most  gratifying  results.  This  may  be  accom- 
plished in  posterior  and  lateral  curvatures. 

We  must  recognize  our  limitations.  We  cannot  cure  everything  and 
there  are  many  cases  that  we  cannot  help.  We  are  limited,  but  we 
have  been  able  to  cure  a  great  number  of  cases.  Osteopathy  has  been  able 
to  cure  more  cases  than  any  other  system. 

A  few  words  as  to  the  methods  used  by  surgeons.  They  are,  in 
spinal  curvatures  chiefly  mechanical,  with  prescriptions  of  drugs  for 
general  health.  One  practice  in  very  general  use  is  to  have  the  patient 
lie  flat  upon  the  back  to  relieve  the  spine  of  the  weight  of  the  body. 
Sometimes  a  bed  frame  is  made  in  this  way:  an  ordinary  iron  pipe  is 
made  into  a  rectangular  frame  long  enough  to  accommodate  the  patient, 


.TYPHOID   FEVER.  243 

and  a  cloth^  is  spread  over  it  and  fastened,  making  a  fixed,  firm  place 
upon  which  to  lie,  and  which  may  be  readily  taken  up.  There  are  vari- 
ous appliances  which  are  used.  Plaster  paris  jackets  are  made.  The 
patient  is  suspended  upon  a  frame  and  bandages  are  applied  as  near  the 
skin  as  possible,  to  a  perfectly  fitting  under  vest.  Sometimes  these 
jackets  are  cut  in  front'  and  laced  so  they  may  be  taken  off,  but  generally 
they  are  left  on.  Leather  and  wire  jackets  are  made,  and  ingeniously 
contrived  and  elaborately  made  braces  of  great  price  are  used.  Objec- 
tions: All  jackets,  etc.,  limit  motion,  prevent  exercise,  are  often  unsan- 
itary, impede  blood  flow.  Braces  often  do  not  fit  and  are  outgrown. 
Mechanical  supports  do  not  allow  the  weak  parts  to  grow  strong.  Such 
contrivances  irritate  nerves  and  often  perpetuate  the  condition  they 
should  cure.  Of  course  the  parts  cannot  be  built  up  and  strengthened, 
because  they  are  depending  upon  something  else.  As  a  rule  we  remove 
these  things,  and  leave  the  patient  to  have  freedom  of  motion. 

Sometimes  they  have  the  patient  assume  a  position  that  will  correct 
the  curvature.  There  is  a  seat  called  Volkman's  seat,  with  the  chair 
seat  raised  upon  one  side,  and  the  patient  sitting  thus,  stops  the  curva- 
ture by  overcorrection.  They  also  have  the  patient  lie  down  on  a  table, 
in  such  a  way  as  to  bend  the  spine.  There  are  various  methods  used. 


LECTURE   IV. 

TYPHOID  FEVER,  (Enteric  fever,  Typhus  abdominalis),  is  described  as 
an  acute,  infectious  (but  not  contagious)  disease.  I  treated  a  case  once 
where  the  lady  next  door  had  bottles  of  carbolic  acid  set  along  on  the 
window  sills.  A  great  many  people  are  afraid  of  it  and  think  it  con- 
tagious. It  is  a  long  continued  fever,  characterized  by  certain  lesions 
of  the  small  intestines,  which  are  the  seat  of  the  disease. 

Aetiology.  Its  cause  is  now  generally  held  to  be  a  specific  micro- 
organism, the  Typhoid  bacillus,  or  bacillus  of  Eberth,  which  invades  the 
body  and  propogates  its  peculiar  poisons,  thus  infecting  the  patient  and 
causing  the  symptoms  of  the  disease. 

Contaminated  water  is  the  chief  avenue  of  entrance  of  the  germ  into 
the  body.  Not  all  bad  water  is  thus  a  carrier  of  disease.  People  often 
use  such  water  with  impunity.  Countless  millions  of  the  bacilli  exist  in 
the  feces  of  the  typhoid  patients.  These  are  frequently  and  criminally 
allowed  to  go  without  disinfection  by  a  good  germicide.  The  water  in 
the  soil  frequently  becomes  contaminated  with  sewage,  which  finds  its 
way  into  wells  or  rivers,  and  thus  into  the  houses  in  the  drinking  water. 
A  heavy,  washing  rain,  in  a  town  or  village  not  well  drained  by  sewers, 


24:4  TYPHOID   FEVER. 

will  wash  the  germs  into  wells  and  cisterns;  or  the  same  heavy  rain, 
cleaning  up  the  large,  well  drained  city,  flushes  its  sewers,  and  carries 
its  impurities  into  the  river  which  supplies  smaller  towns  below  with 
water  for  all  purposes.  I  knew  of  one  case  in  which  a  little  girl,  some 
five  or  six  years  of  age,  in  going  home  from  school,  stopped  at  an  open 
man-hole  in  a  sewer  and  played  about  it  for  a  short  time.  She  was  very 
soon  afterward  taken  with  a  very  bad  case  of  typhoid  fever,  and  the 
cause  was  laid  to  her  playing  about  the  man-hole  of  this  sewer.  Such 
effects  may  occur. 

Cold  does  not  kill  the  germ  Impure  ice  is  often  the  source  of  the 
infection,  as  is  also  adulterated  milk  and  other  articles  of  food.  The  ice 
which  has  been  used  here  I  think  has  been  the  cause  of  a  number  of 
cases,  although  I  do  not  know  that  it  is  so  much  so  at  the  present  time. 
Typhoid  fever  is  not  contagious.  Clergymen,  physicians  and  nurses 
rarely  contract  it.  But  this  accident  sometimes  happens  in  houses  where 
cleanliness  is  not  observed  in  the  matter  of  bed  clothing,  carpets,  linen, 
etc.  Quain  states  that  emanations  from  newly  opened  cesspools,  sewers, 
etc.,  may  cause  the  disease,  rarely  however,  through  atmospheric  conta- 
gion. This  theory,  I  believe,  is  now  held  to  b£  untenable. 

It  becomes  at  once  evident  that  great  care  should  be  taken  to  disin- 
fect the  stools  and  urine,  and  to  adopt  antiseptic  precautions  in  washing 
the  linen. 

Typhoid  usually  occurs  epidemically  in  the  Autumn  (August-No- 
vember), but  in  cities  sporadic  cases  are  continually  noted  at  any  season. 
Some  people  never  take  the  fever,  seeming  to  be  immune.  It  is 
stated  that  heredity  seems  to  predispose  to  an  attack,  it  being  more  for- 
midable in  a  patient  who  has  lost  a  parent  by  the  disease.  One  attack 
does  not  exempt  from  another.  Young,  robust  adults  are  most  fre- 
quently the  victims,  the  disease  seeming  to  avoid  persons  with  chronic 
ailments.  It  is  very  rare  before  one  year  of  age,  less  so  between  one 
year  and  fifteen  years;  most  frequent  between  fifteen  and  thirty  years  of 
age.  Overwork,  mental  depressions,  shock  and  general  debility  are  pre- 
disposing causes.  So  it  is  that  the  child  of  a  parent  who  has  had  a  bad 
case  of  typhoid  fever  may  die  from  the  disease.  Thus  it  is  that  the  child, 
or  the  brother,  or  sister  who  has  watched  at  the  bedside  of  a  patient 
dying  with  the  fever  may  have  the  disease.  The  shock  of  the  loss  of  the 
relative  weakens  the  system,  and  the  patient  is  taken  down.  Such  cases 
occur  very  frequently,  and  without  doubt  it  is  the  mental  shock  which 
is  the  predisposing  cause. 

Typhoid  fever  is  a  disease  of  the  small  intestines,  and  affects  chiefly 
Fever's  patches,  hence  the  name  Ileo-typhus  sometimes  applied  to  it. 

Four  stages  are  marked  by  the  condition  of  rhe  mucous  membrane 
of  the  small  intestines. 


FEVER.  -245 

(1)  In  the  congestive  stage  the  whole  membrane  is  swollen  and  con- 
gested,  covered  with  a  slimy   exudation. 

(2)  In   the   stage   of   infiltration,   the     swelling     concentrates     upon 
Peyer's  patches,  disappearing  in  other  locations.     The  patches  swell  and 
become  of  a  grayish  color.  * 

(3)  In  the  stage  of  softening,  the  glands  burst  and  are  covered  by  a 
crumbly  crust,   or  burst  and  discharge   without  formation   of  crust. 

(4)  In  the  stage  of  ulccration  the  patches   suppurate  and   form  the 
Typhoid  ulcer.     The  whole  gland  may  now  be  sloughed  off  down  to  the 
sub-mucous  fibrous  coat  of  the  intestines,  or  the  muscular  coat  may  be 
eaten  through,  and  perforation  of  the  bowels  takes  place.     Blood  vessels 
may   be    eroded,    resulting   in    hemorrhage.     While   the    ulceration   as   a 
rule  affects  the   Peyer's  glands,  the  latter  may  be  wanting,  or  little  af- 
fected, while  numerous  small  ulcerations  are  scattered  over  the  intestines. 
The  large   intestine   is   rarely  affected;   the  ilio-caecal   valve   marking  the 
limit  of  the  disease.     The  mesenteric  lymphatic  glands  become  infiltrated 
and    enlarged.     The   parenchyma   of   the    liver    and    kidney,    the    muscle 
fibers  of  the  heart,  and  the  involuntary  muscles  generally,  may  undergo 
granular   degeneration.     From   this    cause    heart   failure    may   become   a 
complication. 

Symptoms:  The  period  of  incubation,  in  which  the  germ  grows  in 
numbers  and  gains  a  foothold  in  the  tissues,  is  usually  about  two  weeks, 
but  it  may  vary  to  four.  The  onset  is  usually  insidious;  for  a  few  days 
before  the  attack,  the  patient  suffers  from  headache,  malaise,  general 
weakness,  dizziness,  nose-bleed,  pains  in  the  back,  loss  of  sleep  and  ap- 
petite, coated  tongue,  etc.  The  attack  proper  is  ushered  in  with  a  chill 
and  vomiting.  The  chilly  feeling  may  be  slight  or  wanting.  In  typical 
cases  the  bowels  may  be  relaxed,  and  diarrhoea  be  present,  though  often 
constipation  is  present.  There  is  gurgling  and  tenderness  upon  pressure 
in  the  right  iliac  fossa.  The  attack  may  come  on  violently  with  few 
prodromal  symptoms. 

An  almost  unfailing  sign  of  typhoid  is  the  temperature  variation,  so 
characteristic  a  course  does  its  rise  and  fall  pursue.  During  the  first 
week,  roughly  speaking,  it  rises  until  it  has  reached  103  to  105  degrees 
F. ;  for  another  week,  or  week  and  a  half,  it  remains  high;  then  for  a  week 
to  a  week  and  a  half  it  gradually  descends.  The  manner  of  rise  is  as 
follows:  for  the  first  four  or  five  days  the  temperature  increases  from 
two  to  three  degrees,  with  a  fall  of  one  to  one  and  one  half  degrees  F. 
from  evening  until  morning.  After  reaching  its  level,  it  remains  about 
the  same,  the  morning  temperature  being  about  from  one  to  one  and  a 
half  degrees  lower  than  that  of  the  evening.  During  the  period  of  de- 
cline the  morning  fall  exceeds  the  evening  rise,  until  the  normal  is 
reached. 


246  TYPHOID   FEVER. 

While  the  temperature  is  almost  invariably  characteristic,  it  has  been 
known  to  vary  some  from  the  usual  course. 

Another  important  diagnostic  sign  is  the  rose-colored  rash.  This 
appears  about  the  end  of  the  first  week;  frequently  absent,  estimated 
so  in  about  thirty  per  cent  of  all  cases.  The  spots  are  small,  reddish, 
pale,  about  the  size  of  the  head  of  a  pin.  They  appear  in  successive 
crops  upon  the  abdomen,  chest  and  back,  lasting  until  the  end  of  the 
fever.  They  disappear  upon  pressure.  Individual  spots  may  be  ob- 
served by  being  marked  about  with  ink.  The  spleen  and  liver  are  en- 
larged and  tender. 

The  symptoms,  usually  spoken  of  with  regard  to  the  week  of  the 
disease,  are  in  great  variety,  differing  much  in  different  patients.  Dur- 
ing the  first  week,  in  addition  to  the  weakness,  dizziness,  epistaxis,  etc., 
already  mentioned,  the  abdomen  becomes  tumid,  the  tongue  is  soft  and 
shows  the  imprints  of  the  teeth.  It  is  covered  with  a  fine  white  fur 
which  may  become  heavy,  brown  and  flaky  as  the  disease  progresses. 
At  first  the  edges  of  the  tongue  are  red,  frequently  there  appears  a  red 
streak  down  the  middle,  terminating  in  a  wedge-shaped  red  space  at 
the  tip  of  the  tongue.  The  pupils  of  the  eye  dilate.  During  the  second 
week  the  temperature  keeps  about  104  degrees  F.,  the  pulse  is  weak,  soft, 
often  dicrotic,  and  varies  from  100  to  200  beats;  the  face  assumes  a  stupid 
look,  the  patient  is  very  weak,  lies  upon  the  back,  slips  down  in  bed, 
following  the  weight  of  the  body.  There  is  a-  dizziness,  ringing  in  the 
ears,  a  dry  tongue,  but  the  patient  does  not  ask  for  water;  drinks  when  it 
is  given  to  him.  He  answers  slowly  when  spoken  to,  shows  the  tongue 
with  difficulty,  mutters  and  is  delirious. 

In  the  third  week  the  extreme  weakness  continues.  The  bowels  are 
usually  loose,  owing  to  the  catarrhal  condition  of  the  intestines,  the 
cheeks  are  flushed  or  cyanotic,  the  lips  and  teeth  are  covered  with 
sqrdes;  the  abdomen  is  inflated,  and  the  dependent  parts  of  the  lungs 
solidified.  The  temperature  is  still  high;  there  is  a  jerking  of  the  ten- 
dons (subsultus  tendinum),  the  patient  slides  further  down  in  bed,  and 
the  stools  and  urine  are  apt  to  pass  off  involuntarily.  This  is  the  dan- 
gerous week,  and  the  one  in  which  the  mortality  is  the  greatest.  Bed 
sores  t  frequently  appear  at  this  time,  and  are  to  be  carefully  guarded 
against.  The  patient  is  stupid  and  delirious  and  may  pick  at  the  bed 
clothing.  In  this  week  the  intestinal  hemorrhage  or  the  perforation  of 
the  bowels  may  occur.  The  former  may  not  be  serious,  but  the  latter  is 
usually  fatal.  They  are  often  brought  on  by  some  indiscretion,  such  as 
the  eating  of  solid  food.  The  climax  of  the  disaese  is  now  reached.  The 
patient  may  die  from  perforation,  hemorrhage,  weakness,  or  some  com- 
plication. On  the  other  hand,  all  the  symptoms  may  improve;  the  stupor 
become  natural  sleep;  consciousness  return;  pulse  and  respiration  become 


TYPHOID   FEVER.  247 

normal.  This  continues  during  the  fourth  week,  but  the  patient  recovers 
very  slowly. 

Relapses  are  of  frequent  occurrence.  They  occur  about  ten  days 
after  the  disappearance  of  the  fever. 

Hemorrhages  are  known  by  passage  of  blood  from  the  bowels,  nose 
or  womb.  /  The  patient  near.s  collapse  and  the  temperature  suddenly 
falls.  Perforation  is  known  usually  by  a  sudden  and  intense  pain  in  the 
abdomen,  bloating  (tympanites)  and  collapse.  The  patient  lies  on  his 
back  with  knees  drawn  up.  Peritonitis  follows.  The  countenance  is  pale 
and  wet  with  perspiration.  Thfe  abdominal  walls  are  motionless  in  respi- 
ration. 

Complications  are  common,  e.  g..  pneumonia,  parotitis,  pleurisy,  and 
pulmonary  gangrene.  Various  forms  occur,  e.  g.,  Abortive  typhoid,  in 
which  the  symptoms  are  light,  remission  of  temperature  on  the  eighth 
to  ninth  day ;  walking  or  ambulatory  typhoid,  patient  gets  around,  the 
symptoms  arc  slight,  but  may  suddenly  terminate  in  perforation  or 
hemorrhage. 

Treatment  of  typhoid  fever  requires  great  care  and  careful  nursing. 

1.  Liquid  diet  must  be  strictly  enforced  from  the  onset  until   froii1 
five  to  ten  days  after  the  fever  has  gone.     Milk,  meat  broths,  and  soup 
are  indicated.     The  best  is  milk  with  lime  water  in  it  to  prevent  coagula- 
tion in  the  stomach.     Milk  or  beef  tea  should  be  given  about  every  three 
hours.     From  two  to  four  pints  of  milk  a  day  may  be  given 

2.  Frequent  sponging  (night  and  morning)   with  tepid  water   with  a 
little  vinegar  in  it  should  be  employed.     Hands  and  face  should  be  fre- 
quently  washed.     Sometimes    cold    baths    are    given    every   three   hours. 
The  water  should  be  seventy-five  to  eighty-five  degrees  F.  and  the  bodv 
immersed  in  it  for  a  few  minutes,  the  body  being  well  rubbed  afterward 
to  prevent  internal  congestion. 

3.  Bed  pan  and  urinal  should  be  used  from  the  first,  as  the  extra 
exertion  of  sitting  up  is  a  serious  drain  on  the  patient's  strength.     Patient 
should  never  be  allowed  to  get  up. 

4.  Swab  mouth  with  a   wash  of  equal  parts  of  glycerine  and  water, 
with  lemon  juice  added. 

5.  Diarrhoea  unless  excessive,   more  than   from   three    to  five  times 
daily,  should  not  be  interfered  with. 

In  constipation  use  anema  every  day  or  second  day. 

6.  Keep  feet  and  hands  warm  by  hot  applications.     In  case  of  re- 
lapse and   sudden  fall  of  temperature  heat  up  well  and  quickly  by  hot 
applications. 

7.  Return  to  solid  food  very  slowly.     Not  earlier  than  from  five  to 
ten  days  after  the  fever  has  left.     In  all  treatment  avoid  carbo-hydrates, 
(starches,   etc.) — such  foods   as  are   digested  in   the   intestines.     No   fat, 


248  TYPHOID   FEVER. 

etc.  The  solid  food  may  be  egg,  lightly  boiled  or  poached;  very  soft 
boiled  rice,  curds,  and  whey.  Care  should  be  taken  as  the  patient  always 
has  a  ravenous  appetite,  and  there  is  great  danger  of  over  feeding. 

8.  Plenty  of  water — boiled — should  be  given.  You  may  give  toast 
water,  barley  water,  etc. 

The  object  of  medical  treatment  is  simply  palliative,  Hare  declaring 
that  the  course  of  the  disease  cannot  be  shortened.  However,  Dr.  Golt- 
man,  of  Memphis,  Tenn..  in  the  Medical  Record,  New  York,  September 
17,  1898,  states  his  belief  to  be  that  early  and  rigorous  eliminative  treat- 
ment may  cause  a  shorter  or  milder  course  by  lessening  toxaemia.  In 
medical  treatment  as  in  Osteopathic  treatment,  great  reliance  is  placed 
upon  proper  nursing,  but  the  former  indicates  a  long  list  of  drugs  for 
the  various  phases  of  the  disease. 

OSTEOPATHIC  TREATMENT,  if  early  and  thorough,  is  highly  successful, 
in  most  cases,  generally  shortening  the  course,  and  in  most  of  the  re- 
mainder keeping  down  the  fever  and  the  untoward  symptoms  that  con- 
sume the  patient's  vitality.  Dr.  Conner,  of  much  experience,  states  that 
he  can  usually  have  the  fever  broken  up  within  two  weeks.  Dr.  McCon- 
nell  states  that  by  early  and  radical  treatment  the  course  may  be  short- 
ened to  five  days  or  less. 

Q.  Would  it  not  be  injurious  to  take  the  patient  out  of  bed  to  give 
him  a  bath? 

A.     Not  necessarily  so,  as  he  could  be  lifted  out  and  back. 

Q.     How  soon  would  you  reduce  the  fever? 

A.  As  soon  and  as  much  as  you  can.  Of  course  it  does  not  stay 
down,  but  we  keep  at  it.  We  always  make  it  a  practice  to  keep  it  down 
as  much  as  possible. 

Q.     How  often  do  you  treat  a  patient  for  typhoid  fever? 

A.  You  should  go  to  see  your  patient  two  or  three  times  a  day. 
and  make  it  convenient  to  go  several  other  times  to  see  if  he  is  getting 
along  all  right.  You  should  give  at  least  two  treatments  a  day. 

Treatment  Procedure  by  Osteopathy:  You  will  find  your  patient  very 
nervous,  muscles  twitching,  and  perhaps  irritable.  You  can  reduce  the 
nervousness  and  twitching  by  carefully  relaxing  the  muscles  along  the 
spine.  I  have  the  patient  turned  on  the  side,  with  as  little  effort  on  his 
part  as  possible,  and  relax  all  of  the  muscles  along  the  spine  on  both 
sides.  I  do  not  usually  put  him  to  the  trouble  of  being  turned  over  to 
the  other  side.  I  reach  over  to  the  muscles  on  the  under  side.  You  can 
in  this  way  get  the  effect  on  both  sfdes,  and  the  next  time  you  can  have 
him  turned  on  the  other  side. 

You  will  find  that  by  treatment  along  the  spine,  and  by  gentle  treat- 
ment in  the  neck  you  can  usually  quiet  the  patient.  Treat  in  the  neck 
at  the  superior  cervical  region.  The  idea  is  to  get  the  hand  flat  against 


TYPHOID   FEVER.  249 

these  muscles  which  are  drawn  and  sore,  and  gently  turn  the  head  to 
one  side  so  that  you  can  relax  the  tension.  That  relieves  the  tension  and 
aids  the  blood  flow.  The  spinal  treatment  and  treatment  in  the  neck  are 
for  these  symptoms  of  nervousness.  The  theory  is  that  we  affect  the 
posterior  spinal  nerves  and  get  the  effect  through  the  terminal  sensory 
fibres  to  the  sympathetic  nervous  system,  and  out  through  it  to  the  vaso 
motor,  and  thus  equalize  the  circulation.  Our  theory  here  of  work  upon 
the  superior  cervical  region  is  that  we  reach  the  sub  and  great  occipital 
nerves  and  the  general  circulation  through  the  medulla,  in  that  way 
quieting  the  nerves. 

There  are  special  points  which  are  included  between  the  second  dor- 
sal and  the^  fourth  lumbar,  (a)  From  the  second  to  the  seventh  dorsal 
to  relieve  the  lungs,  as  you  know  pneumonia  is  one  of  the  complica- 
tions, (b)  Work  gently  from  the  fifth  to  the  tenth  dorsal  for  the  effect 
upon  the  jejunum,  (c)  From  the  tenth  dorsal  to  the  first  lumbar  fot 
the  ilium.  We  do  the  most  of  our  work  from  the  tenth  dorsal  to  the 
first  lumbar  because  the  small  intestine  is  affected.  You  may  work  from  the 
first  to  the  fourth  lumbar  to  affect  the  large  intestine,  (d)  From  the  sixth 
dorsal  to  the  second  lumbar  to  affect  the  kidneys.  All  your  work  along 
here  must  be  very  gentle.  Work  against  the  muscles  gently,  particularly 
from  the  tenth  dorsal  down  to  the  fourth  lumbar.  I  work  gently,  spring- 
ing the  spine  all  the  way  along  toward  me,  as  that  will  stimulate  and 
relieve  the  nerves.  The  spleen  must  be  looked  after  in  the  splanchnic 
region  from  the  eighth  to  the  twelfth  on  the  left  side.  The  ribs  from  the 
eighth  to  the  twelfth  on  the  left  side  must  be  raised  gently.  I  would 
not  take  up  the  arms  of  the  patient.  I  would  reach  under  him  and 
raise  them.  Work  over  the  abdomen,  and  under  the  ribs  in  front,  not 
hard,  as  the  spleen  and  liver  are  likely  to  be  congested  and  you  must 
not  work  hard  on  that  account.  In  diarrhoea,  where  there  are  more 
than  three  or  four  stools  in  a  day,  we  inhibit  the  ninth,  tenth  and  elev- 
enth dorsal,  the  eleventh  especially,  by  holding  against  this  point,  the 
patient  upon  the  side,  and  by  springing  the  spine.  I  go  also  to  the  lum- 
bar region,  and  hold  at  the  heads  of  the  eleventh  and  twelfth  ribs.  The 
theory  there  is  that  springing  the  spine  and  gently  raising  the  ribs  re- 
leases any  tension  upon  the  spinal  nerves,  and  through  them  affects  the 
sympathetics  ruling  the  organs  mentioned.  Also  treat  gently  the  second 
dorsal  and  fifth  lumbar  to  influence  the  superficial  fascia  and  thus  influ- 
ence the  general  circulation  of  the  blood;  the  cutaneous  circulation. 

Fever: — I  take  down  the  fever  by  work  in  the  superior  cervical  region, 
as  1  have  already  shown  you.  I  hold  flat  against  the  sub  and  great 
occipitals  for  a  long  time.  Do  not  be  in  a  hurry.  You  can  hold  there 
several  minutes  if  you  wish,  and  turn  the  head  from  side  to  side,  gently. 
I  also  inhibit  by  springing  the  arm  up  a  little,  or  by  pressing  in  against 


250  MALARIA. 

the  heads  of  the  upper  ribs  on  the  left  side,  from  the  first  to  the  fifth  to 
help  quiet  the  heart.  In  extreme  cases  where  the  heart  beat  is  from 
one  hundred  and  thirty  to  one  hundred  and  forty,  Dr.  Hildreth  says  he 
has  had  fairly  good  success  by  raising  the  fifth  rib  on  the  left  side.  I 
would  work  under  the  angles  behind  and  raise  both  the  angle  and  the 
tip.  Also  you  will  need  to  lower  the  first  rib  gently  by  pressing  behind 
the  clavicle. 

The  abdominal  treatment  is  one  that  must  be  given  very  gently. 
We  work  in  the  iliac  fossa  on  each  side.  I  knead  gently,  not 
with  the  idea  of  helping  the  constipation,  but  of  getting  in  deep  amor^* 
the  intestines  and  relaxing  the  tension  upon  the  lower  hypogastric  and 
pelvic  plexuses,  by  a  gentle  touch  to  relieve  the  tension.  Now,  this 
work  over  the  liver  and  spleen  seems  to  relieve  the  tension,  takes  out 
the  soreness,  and  thus  probably,  prevents  the  degeneration  spoken  of  in 
the  spleen,  by  freeing  the  blood  flow,  as  well  as  prevents  ulceration  in 
the  bowel.  Probably  also  there  is  degeneration  of  the  involuntary  mus- 
cles of  the  heart,  and  as  soon  as  you  can  do  so  you  should  give  a  stim- 
ulating treatment  to  restore  the  vitality. 

Suppose  you  have  a  hemorrhage?  Osteopathic  treatment  there 
would  be  as  far  as  possible  to  inhibit  the  peristalsis,  at  the  ninth,  tenth 
and  .eleventh  dorsal  vertebrae.  The  best  thing  to  do  is  to  immediately 
place  an  ice  bag  over  the  caecum  to  contract  the  blood  vessels  and  stop 
the  hemorrhage,  while  on  the  other  hand,  if  you  have  perforation  of  the 
bowels,  which  is  sudden,  and  may  be  noticed  by  the  fixation  of  the 
abdominal  walls,  etc.,  hot  applications  are  used  over  the  bowels  and 
lower  limbs,  to  relieve  the  pain.  Ifv perforation  occurs  you  are  almost 
sure  to  lose  your  patient. 

The  patient's  room  should  be  quiet  and  clean,  with  good  ventilation, 
plenty  of  fresh  air,  diligent  nursing  and  frequent  Osteopathic  treatment, 
but  not  enough  to  in  any  way  worry  the  patient.  Guard  against  relapses 
from  over  eating. 


LECTURE  V. 

Malaria,  called  also  Marsh  Miasm,  Intermittent  Fever,  Fever  and 
Ague,  is  an  endemic  disease,  dependent  upon  the  presence,  in  the  infected 
locality,  of  a  specific  poison  generated  by  a  protozoon  germ,  Plasmodium 
Malariae,  or  Haematozoon  of  Leveran. 

The  term  Malaria  is  commonly  used  in  a  general  sense,  to  denote  a 
class  of  intermittent  and  remittent  fevers  known  as  the  Malarial  fevers  or 
diseases.  This  class  of  fevers  is  characterized  by  enlargement  of  the 


MALARIA.  251 

spleen  and  liver,  paroxysmal  periodicity,  ^aod  the  presence  in  the  blood, 
either  free  or  within  the  corpuscles,  of  various  forms  of  the  above  men- 
tioned parasite. 

Aetiology: — The  cause  of  this  disease  is  peculiar,  and  not  well  under- 
stood. Although  described  by  early  writers  as  the  "Bacillus"  Malariae,  it 
is  now  generally  admitted  to  belong  not  to  the  class  of  bacteria,  but  to 
the  class  of  protozoa.  It  is  generated  in  swampy  places,  as  the  name 
(marsh  miasm)  implies,  though  by  no  means  there  exclusively.  It  occurs 
chiefly  in  tropical  climates,  and  in  places  where  strong  heat  from  the 
direct  rays  of  the  sun,  moisture,  and  decaying  vegetable  matter  are  present. 
It  is  often  met  with  in  localities  where  the  soil  is  rich  in  organic  matter. 
When  the  natural  drainage  outlets  of  a  locality  become  clogged,  the 
ground  becomes  water-logged,  and  malaria  is  very  apt  to  be  developed. 
Malaria  is  also  known  in  some  dry,  arid  regions.  Large  tracts  of  arable 
land,  left  without  cultivation,  frequently  become  malarious.  Digging  up 
of  the  soil,  e.  g.,  for  the  purpose  of  putting  in  an  extensive  sewer  system, 
has  long  been  known  as  a  cause  of  epidemics  of  the  fever. 

The  fertile  strips  of  soil  at  the  bases  of  mountain  ranges  in  tropical 
countries  are  seats  of  the  miasm,  e.  g.,  base  of  the  Himalayas,  where 
the  soil,  rich,  well  watered,  and  covered  with  forests,  is  notably  malarious. 
Certain  rocks,  disintegrating,  exposed  to  sun  and  air  in  tropical  countries, 
are  said  to  be  productive  of  the  poison,  e.  g.,  granite  rocks,  which  are 
highly  absorbent  of  moisture.  When  you  come  to  consider  that  the  rocks 
are  one  of  the  best  fertilizers  known,  then  you  have  some  idea  how  they 
may  increase  the  value  of  the  ground  by  fertilizing  it. 

Decaying  vegetable  matter  in  the  bilge  water  of  ships  has  been  as- 
signed as  the  cause  of  an  outbreak  of  malaria. 

Certain  low  lands  along  rivers  are  known  to  be  especially  infected. 
Our  Chariton  River,  it  is  said,  is  infected  more  on  one  side  than  on  the 
other.  On  the  west  side  the  people  are  very  apt  to  be  malarious,  while 
those  on  the  east  side  are  not. 

New  places,  just  under  cultivation,  and  places  with  a  damp  subsoil, 
though  the  upper  crust  is  dry,  are  very  frequently  affected. 

Characteristics: — Malaria  is  described  by  Green  as  being  strictly  en- 
demic, i.  e.,  limited  to  certain  localities.  The  disease  must  be  contracted, 
here  though  it  may  manifest  itself  elsewhere.  This  would  seem  most 
natural  from  the  nature  of  the  cause.  However,  epidemics  of  malaria  are 
common  occurrences,  while  sporadic  cases  are  known.  Raue  says  it  is 
not  known  why  epidemics  and  sporadic  cases  should  occur,  as  they  have 
been  known  to  occur,  in  localities  which  have  never  manifested  malarial 
infections,  in  individuals  who  had  not  left  the  locality. 


252  MALAR!A. 

TA^OSTcO    nO   3£3JJOO 

The  disease  is  not  c,onta^iai\s ;  it  cannot  be  carried  by  one  person  to 
aridthei*  One  person  may  be  infected  from  another,  says  Green,  only  by 
direct  intravenous  inoculation. 

The  miasm  seems  to  travel  with  air  currents,  and  in  certain  definite 
plains.  It  may  be  stopped  by  a  hedge  or  a  wall,  unless  a  strong  breeze 
carries  it  over.  It  may  be  found  only  upon  one  side  of  a  river,  the  other 
side  being  entirely  free  from  it.  A  forest  belt  is  often  a  barrier.  Under 
proper  conditions  it  may  travel  long  distances  upon  air  currents,  provided 
the  strength  of  the  breeze  be  not  sufficient  to  dispel  the  germs.  They  may 
rise  with  currents  of  heated  air  to  considerable  altitudes  which  are  other- 
wise healthful.  They  have  been  known  thus  to  ascend  along  ravines  up 
mountains  from  five  hundred  to  three  thousand  feet  in  height.  Thus  it  is 
sometimes  unsafe  to  place  a  dwelling  near  the  edge  of  a  ravine. 

The  virulence  of  the  miasm  varies  some  with  the  temperature,  locali- 
ties which  are  unhealthful  in  summer  an'd  autumn,  becoming  safe  in  the 
winter  season. 

There  is  a  theory  that  the  system  of  the  host  may  become  inoculated 
through  the  bite  of  insects,  e.  g.,  mosquitoes.  However  this  theory, 
though  probable,  is  questioned. 

The  Germ:  As  stated  above,  the  germ  of  this  disease  is  not  a  bac- 
terium, but  a  protozoon.  It  is  always  present  in  the  blood  in  malaria, 
either  free  in  the  serum,  or  within  the  red  corpuscles.  Its  action  upon  the 
blood  is  marked,  it  being  extremely  destructive  of  the  red  corpuscles.  Quain 
states  that  Prof.  Keltch  has  shown  that  in  24  hours,  a  man  affected  with 
malaria  lost  more  than  a  million  globules  per  cubic  millimeter.  Thus  the 
patient  becomes  anemic,  and  this  state  of  the  blood  causes  murmurs  about 
the  heart,  which  may  lead  to  a  mistaken  diagnosis.  The  germ  is  seen  in 
different  forms  at  different  times.  The  form  free  within  the  liquor  sangu- 
inis  is  minute,  globular,  and  possessed  of  amoeboid  movements.  This 
seems  to  be  the  primary  form.  Again,  the  germ  is  seen  within  the  red 
blood  corpuscles,  amoebo'id,  pigmented.  Agajn,  a  large,  pigmented,  in- 
tracorpuscular  form  is  seen ;  then  an  intracorpuscular,  rosette  form,  with 
the  pigment  aggregated  at  the  center;  or  the  flagellated  form  is  seen  free. 

Some  writers  maintain  that  the  above  forms  are  different  stages  in 
the  growth  of  the  organism.  It  may,  further,  be  crescentic  in  shape,  or 
become  flagellated,  the  flagellae  lashing  about  in  the  liquor  sanguinis. 

It  is  stated  that  the  severe  types  of  malaria  in  tropical  countries  are 
particularly  connected  with  the  appearance  of  the  crescent-shaped  germ, 
and  that  in  temperate  climates  the  crescentic  form  is  rarely  present,  the 
flagellated  form  being  produced  immediately  from  the  intracorpuscular 
discs.  Leveran  first  discovered  the  germ. 

Pathology  and  Symptomatology:  The  diagnosis  of  Malaria  (typical) 
never  fails  on  account  of  the  clock-work-like  periodicity  of  the  phases  of 


MALARIA.  253 

the  disease.     Hence   the  name  paroxysmal.     There  are   three  stages;  the 
chill,  the  fever,  and  the  sweat. 

The  chilly  stage  lasts  from  a  few  moments  to  three  hours.  The 
patient's  appearance  is  marked.  The  features  shrink;  there  is  a  chill, 
which  may  he  violent;  there  may  be  vertigo,  and  nausea.  The  chill  may 
(  be  limited  to  a  slight  chilly  sensation  along  the  spine.  Ordinarily  the  whole 
surface  is  cold,  the  face  is  pale ;  the  nose  becomes  pinched ;  the  breathing 
is  shallow  and  quick;  the  pulse  is  small  and  rapid;  but  the  internal  tem- 
perature rises  rapidly  from  two  to  seven  degrees.  Various  symptoms 
attend  this  stage,  such  as  headache,  backache,  cough,  thirst,  colic,  etc. 

The  second  stage  lasts  a  variable  number  of  hours,  from  two  or  three 
to  ten  or  twelve.  It  comes  on  gradually,  the  body  recovering  from  the 
chill,  the  temperature  continuing  to  rise  until  it  reaches  a  height  varying 
from  100  degrees  to  108  or  even  109.49  degrees  F.  Various  symptoms 
attend  this  stage. 

The  third  stage  also  lasts  a  variable  number  of  hours.  In  it  the  fever 
gives  away  to  a  profuse  perspiration,  greatly  relieving  the  patient,  the  tem- 
perature declining  to  normal  or  near  normal.  This  stage  ends  the  par- 
oxysm. 

The  patient  now  may  feel  quite  well,  the  paroxysm  not  returning  until 
the  next  day,  in  which  case  the  type  is  called  "quotidian,"  or  the  paroxysm 
is  absent  until  the  second  day,  ("tertian"  type),  or  finally,  until  the  third 
day,  constituting  the  "quartan"  type.  Owing  to  this  peculiarity,  the  patient 
often  feels  quite  well  and  wants  to  go  to  his  usual  occupation.  After  he  is 
well  there  is  a  tendency  to  the  return  of  the  trouble  on  the  fifth,  seventh, 
ninth  or  fourteenth  day.  The  stage  between  paroxysms  is  called  the  stage 
of  Apyrexia.  The  fever  is  called  intermittent  on  account  of  the  intermis- 
sion between  paroxysms.  If  the  stage  follows  in  the  order  given,  the  fever 
is  "intermittcns  completa"  ;  if  one  stage  is  lacking,  "intcrmittcns  incom- 
plete,";  if  in  reverse  order,  "inter mittens  inversa".  The  most  usual  forms 
are  said  to  be  the  quotidian  and  the  tertian.  The  paroxysms,  instead  of 
occurring  at  regular  intervals,  may  come  each  time  earlier  (anticipating), 
or  later  (postponing). 

The  fever  is  said  to  be  remittent  when  between  the  paroxysms  the  tem- 
perature is  lessened,  but  the  fever  merely  slackens,  and  exacerbation  recurs 
immediately.  The  intermittent  fever  may  vary  in  form,  being  gastric  or 
bilious,  and  attended  with  gastric  derangement;  typhoid,  simulating  that 
fever ;  or  of  a  grave  form  leading  to  a  rapid  collapse.  The  symptoms  of 
the  latter  form  are  great  weakness,  derangement  of  most  of  the  organs, 
icterus,  bleeding  of  nose,  stomach  or  kidneys,  dysentery,  etc. 

When  the  patient  has  resided  long  in  a  malarial  region,  and  has  gotten 
the  system  full  of  the  poison,  a  low  state  of  vitality  exists,  with  various 


254  MALARIA. 

symptoms  characteristic  of  the  malaria,  but  in  mild  form.     This  is  called 
''Malarial  Cachexia." 

"Dumb  Ague"  is  the  name  given  to  a  variety  of  malaria,  sometimes 
acute  but  usually  chronic,  in  which  the  sequence  of  chill,  fever  and  sweat 
does  not  occur.  The  symptoms  are  irregular  chilly  sensations,  flushes, 
pains  in  joints  and  muscles,  bronchial  troubles,  headache  and  neuralgia,  etc. 

Enlargement  of  the  spleen  (ague  cake)  and  liver,  with  soreness  of 
both,  is  a  usual  feature  of  all  these  forms,  as  well  as  a  constant  feature 
of  the  regular  form.  These  both,  and  the  spinal  cord,  become  pigmented, 
probably  through  destruction  of  the  red  corpuscles.  The  urine  is  often 
irritating  during  the  paroxysm. 

Treatment: — Now  as  to  medical  treatment,  quinine  is  the  stock  rem- 
edy, and  is  said  to  destroy  the  germ. 

The  Osteopath  wants  to  get  rid  of  the  fever  and  of  the  poison.  He 
stimulates,  as  far  as  possible,  all  of  the  avenues  of  excretion,  the  bowels, 
kidneys,  liver  and  the  lungs,  in  the  ways  already  indicated.  It  will  not 
be  necessary  for  me  to  indicate  this  to  you ;  simple  and  general  stimulation 
of  the  excretory  system.  I  think  you  all  know  the  points  at  which  you 
work.  The  second  dorsal  to  the  seventh  dorsal,  and  also  the  fascia  at 
the  second  dorsal  and  fifth  lumbar,  in  all  stages  generally  treat  this  way. 
lalso  treat  the  liver  in  a  way  with  which  you  are  familiar,  and  the  spleen. 
Work  gently,  as  you  must  bear  in  mind  that  these  two  organs  are  very 
likely  to  be  congested  in  any  such  case  as  this,  and  you  must  not  run 
the  risk  of  rupturing  them.  For  chill,  relieve  the  internal  congestion,  and 
thus  relieve  the  chill  by  stimulating  the  heart  and  the  superior  cervical 
ganglion.  Stimulate  the  lungs  as  well,  by  raising  the  ribs  from  the  second 
to  the  seventh  on  both  sides.  Give  also  a  thorough  spinal  treatment.  If 
you  stimulate  the  spine  all  the  way  along  you  thus  restore  the  circulation. 
When  you  find  the  body  chilly,  warm  the  patient  by  hot  applications  to  the 
spine,  feet,  and  axilla.  Also  give  hot  drinks  and  hot  foot  baths.  Hare 
says  the  action  of  the  poison  at  this  stage  of  the  chill  has  congested  and 
engorged  the  thoracic  and  abdominal  organs.  Work  especially  upon  the 
splanchnics  and  solar  plexus  in  front,  and  over  the  abdomen  in  front 
to  get  rid  of  the  congestion  about  the  abdominal  viscera ;  and  the  stimula- 
tion about  the  lungs  already  described,  would  get  rid  of  the  congestion 
about  the  thoracic  viscera. 

As  to  the  fever,  you  treat  it  as  any  other  fever.  Cold  sponging  and 
cold  drinks  have  been  advocated  by  Hare.  Besides  that,  Osteopathically 
slow  the  heart's  action  by  inhibiting.  You  raise  the  arm  and  hold  back- 
on  the  shoulder  for  a  minute  or  a  minute  and  a  half,  and  this  will  slow 
the  heart's  action.  Inhibit  the  superior  cervical,  the  splanchnics,  and  the 
lower  lumbar  to  equalize  the  circulation.  In  the  stage  of  sweating  you 
should  let  the  patient  alone,  as  the  perspiration  removes  the  poison,  caus- 


RHEUMATISM.  255 

ing  the  patient  to  feel  better.  Give  plerty  of  water  to  drink,  and  encoui- 
age  the  perspiration  by  wrapping  up  warmly.  Give  hot  foot  baths,  also 
stimulate  the  superior  ganglia  and  lungs  to  help  this  improvement.  The 
constipation  and  diarrhoea  you  know  how  to  treat,  as  before  indicated. 
In  the  period  of  apyrexia,  give  a  thorough  general  treatment  for  tonic 
effect. 

I  might  say  our  success  is  good  in  malaria  if  the  case  is  taken  in 
time,  but  if  the  disease  has  been  coming  on  for  some  time  it  is  more 
difficult  to  cure.  Some  two  or  three  months  ago  a  young  man  came, to 
my  house  on  Sunday  with  his  face  flushed,  and  the  malarial  symptoms 
very  perceptible.  I  treated  him  that  day  and  the  next.  He  remained  at 
home  several  days,  but  he  was  out  within  a  few  days. 

Where  you  have  a  malarial  constitution  it  will  probably  take  some 
time  to  work  this  poison  out  of  the  system.  I  have  had  cases  where  they 
would  have  chills  once  a  week.  You  can  stop  the  chills  and  relieve  all 
the  symptoms.. 


LECTURE   VI. 

The  various  forms  of  Rheumatism  are  among  the  cases  that  the 
Osteopath  is  called  upon  most  frequently  to  treat.  The  fact  that  most  of 
these  cases  have  become  long  standing  chronic  cases  makes  the  average 
case  of  rheumatism  somewhat  difficult  to  handle  and  slow  to  cure.  Very 
serious  cases  of  deformity  resulting  from  the  disease  present  themselves 
for  treatment.  Frequently  parts  are  dislocated,  e.  g.,  hip,  knee,  lower 
jaw,  etc.,  simply  in  the  progress  of  the  disease.  I  have  had  several  such 
cases.  One  case  was  of  a  man  in  this  town  who  had  been  affected  with 
Rheumatism  for  some  years,  but  one  day  he  went  up  town,. and  while 
walking  his  hip  became  dislocated.  It  shows  you  the  drawing  power  of 
contraction  in  disease.  I  have  seen  more  than  one  case  where  the  lower 
jaw  had  been  dislocated  from  the  same  reason.  Joints  'become  enlarged 
by  the  growth  of  tissues;  the  synovial  membranes  are  destroyed  and 
chalky  deposits  are  formed  in  the  joints.  One  of  the  most  frequent 
phenomena  you  will  witness  in  connection  with  Rheumatism,  is  the 
enlargement  of  the  joints,  for  the  reason  that  these  cases,  in  the  majority 
of  instances,  become  chronic  and  this  chalky  deposit  is  formed.  Conse- 
quently it  becomes  one  of  the  main  points  in  the  diagnosis  of  Rheuma- 
tism. Hence  it  is  not  strange  that  the  Osteopath  frequently  finds  himself 
confronted  by  cases,  certain  features  of  which  are  beyond  his  skill,  while 
at  best,  they,  as  a  whole,  are  slow  and  unsatisfactory.  It  is  rare,  how- 
ever, that  the  Osteopath  cannot  afford  immediate  relief  from  pain  in  any 


256  RHEUMATISM. 

case  of  Rheumatism,  and,  almost  without  exception,  cases  coming  under 
his  care  are  greatly  benefited  in  most  particulars.  He  can  reset  the 
dislocated  joints,  relax  the  rigid  muscles,  absorb  to  some  extent  the 
articular  deposits,  and  give  new  freedom  to  stiffened  joints.  In  almost 
any  case  of  acute  Rheumatism,  whether  muscular  or  articular,  his  success 
is  practically  assured,  while  in  chronic  cases  he  may  usually  obtain  good 
results.  Hence  the  success  of  Osteopathy  as  a  treatment  for  all  forms 
of  Rheumatism  is  marked.  The  fact  that  so  many  cases  are  of  years' 
standing,  coupled  with  the  fact  that  the  patient  frequently  cannot  con- 
tinue the  treatment  for  a  sufficient  length  of  time  to  obtain  the  best 
results,  makes  the  average  of  the  cases  coming  under  the  treatment  slow 
and  difficult. 

In  the  special  forms  of  this  disease,  such  as  Lumbago,  Torticollis, 
Pleurodynia,  etc.,  the  treatment  is  very  successful. 

There  are  several  forms  of  Rheumatism,  commonly  met  with:  Acute 
Rheumatism,  known  also  as  Rheumatic  fever  and  Acute  Articular  Rheu- 
matism; Chronic  Articular  Rheumatism,  and  Muscular  Rheumatism. 
These  three  forms  of  Rheumatism  are  separate  forms.  Chronic  Articular 
Rheumatism  does  not  necessarily  follow  the  Acute  or  Rheumatic  Fever, 
although  the  latter  may  develop  into  the  former.  Sometimes  the  person 
is  attacked  from  the  beginning  with  this  so-called  chronic  form  of 
Articular  Rheumatism.  They  seem  to  be  distinct  from  each  other,  though 
the  articular  forms,  'both  acute  and  chronic,  are  due  to  similar  causes, 
and  the  latter  often  results  from  repeated  attacks  of  the  former.  The 
muscular  form  is  often  complicated  with  the  other  forms. 

Raue  makes  the  following  general  statement  regarding  this  disease, 
ist.  "It  attacks  either  the  fibrous  tissues,  joints,  aponeuroses,  the  sheaths 
of  the  tendons,  the  neurilemma,  the  periosteum,  or  the  muscles  and 
tendons.  2.  It  is  a  peculiar,  painful  affection,  caused,  no  doubt,  by 
inflammation  and  nutritive  disturbances;  and,  3.  It  comes  on  inde- 
pendently of  other  acute  or  chronic  diseases,  or  traumatic  causes,  etc." 

Rheumatic  Fever,  (Acute  Articular  Rheumatism),  is  an  acute,  febrile 
disease,  a  constitutional  disturbance,  characterized  by  fever,  sweats,  and 
inflammation  of  the  joints  and  serous  membrane  of  the  body.  The  ten- 
dency it  manifests  of  attacking  any  serous  membrane  makes  it  frequently 
a  dangerous  disease. 

Aetiology: — As  to  the  causes  of  the  disease,  they  are  two  fold;  pre- 
disposing and  exciting.  Among  the  former  are  heredity,  27  per  cent; 
previous  attacks;  occupation,  such  as  hard  out  door  labor  under  exposure 
to  the  weather;  social  position,  poverty  being  a  frequent  cause;  and  resi- 
dence in  certain  districts. 

Among  the  exciting  causes  are  infection,  this  being  considered  by 
some  a  disease  caused  by  micrococci  in  the  system;  exposure  to  wet  and 


RHEUMATISM.  257 

cold;  strains  and  muscular  sprains;  chills  from  overheating;  derangement 
of  the  stomach  and  liyer  from  the  eating  of  rich  food;  mental  effects, 
such  as  despondency  and  depression;  exhaustion  from  sickness,  lactation, 
uterine  disease,  etc. 

Some  authorities  hold  that  there  is  accumulation  of  lactic  acid  in 
the  system,  acting  as  a  poison  to  the  tissues.  Others  hold  that  chilling 
of  the  surface  of  the  body  causes  derangement  of  the  parts  of  the  central 
nervous  system  and  vaso-motor  disturbances,  or  pain,  or  trophic  changes. 
In  regard  to  the  chilling  of  the  surface  of  the  body  and  this  affecting  the 
central  nervous  system,  you  see  here  it  is  given  plainly  in  the  aetiology 
of  such  a  condition  as  rheumatism. 

We  generally  understand  a  cold  to  foe  a  congestion,  but  it  has  been 
suggested  that  it  may  be  due  to  a  nervous  disturbance  from  chill.  If 
your  feet  are  wet  or  exposed,  the  result  may  be  a  cold  in  the  head.  It  is 
clear  in  numerous  respects,  and  I  think  the  hypothesis  of  nerve  causes  is 
a  very  reasonable  one.  Some  regard  a  chill  as  affecting  nutrition,  caus- 
ing the  retention  of  the  lactic  or  other  acid,  which  in  turn  affects  the 
nervous  system,  causing  affection  of  the  joints.  There  is  a  germ  theory, 
a  specific  organism  being  suspected;  and  a  malarial  theory,  that  it  is  due 
to  miasm,  or  poison  generated  outside  of  the  body.  The  general  differ- 
ence between  the  bacterial  infection  and  the  infection  of  miasm  is  that 
the  bacteria  get  a  foot-hold  and  propogate  the  poisons  in  the  system  as 
in  typhoid  fever,  while  on  the  other  hand  in  malaria,  the  miasm  is  gen- 
erated outside  of  the  body,  and  the  poison  formed  is  taken  into  the 
system  by  the  person  visiting  the  locality  infected  by  the  poison. 

All  this  goes  to  show  that  the  nature  of  the  disease  is  not  well  under- 
stood, although  a  late  writer  says ;  "It  is  apparently  becoming  more  and 
more  recognized  as  a  purely  infectious  disease."  (Raue.) 

Pathology: — Structural  changes  in  the  joints  are  sometimes  very 
slight,  following  the  inflammation  of  the  synovial  membrane;  merely  a 
slight  exudation  containing  a  few  pus  cells  and  but  little  fibrin  is  noted. 
There  is  oedema  in  the  cellular  tissue  about  the  affected  joint,  causing  a 
visible  swelling.  One  of  the  most  frequent  symptoms  that  you  will  note 
in  cases  of  rheumatism,  whether  of  long  standing  or  recent,  is  that  the 
joints  will  swell.  I  am  treating  a  case  now  in  which  the  two  fingers  on 
the  left  hand  will  swell.  Sometimes  it  will  be  in  the  hand,  and  sometimes 
about  the  various  joints. 

In  severe  inflammation  of  the  synovial  membrane,  considerable  pus 
and  fibrin  are  present  in  the  exudation,  and  the  ends  of  the  bones  may 
become  infiltrated.  The  heart  and  large  blood  vessels  contain  a  large 
amount  of  fibrin;  the  cartilages  of  the  joints  probably  suffer  inflammatory 
changes.  When  there  has  been  much  fever,  there  is  apt  to  be  granular 
degeneration  of  the  liver  and  other  solid  viscera.  The  inflammation 


258  RHEUMATISM. 

frequently  attacks  the  heart,  or  lungs,  or  pleura.  It  may  attack  the 
peritoneum,  larynx,  testes,  or  renal  tubules  of  the  kidneys.  There  may 
be  congestion  of  the  lungs,  pericarditis,  myocarditis,  or  endocarditis.  It 
is  this  tendency  of  Rheumatic  fever  to  attack  the  heart  especially,  and  the 
lungs,  that  renders  h  so  often  fatal.  It  is  said  that  about  twenty  per 
cent  of  all  cases  are  complicated  with  endocarditis,  fourteen  per  cent 
with  pericarditis,  while  myocarditis  is  quite  rare.  Pleuritis,  pneumonia 
and  meningitis  are  still  less  frequent. 

Symptoms: — Three  prominent  and  constant  symptoms  of  Rheumatic 
fever  are,  fever,  sweats  and  arthritis.  The  fever  is  variable,  frequently, 
but  often  follows  a  tolerably  regular  course.  It  is  present  at  the  outset, 
and  lasts  as  long  as  the  disease  preserves  its  acute  character.  Usually 
the  temperature  does  not  exceed  the  normal  more  than  one  or  two 
degrees.  It  is  'usually  moderate  if  the  joint  symptoms  are  so,  but  may 
rise  to  104  or  104.90  degrees  F.,  under  an  opposite  condition  of  affairs. 
Sometimes  the  fever  rises  rapidly  and  becomes  very  high  without  respect 
to  other  symptoms.  The  fever  is  remittent  in  type,  rising  from  one- 
fourth  to  one  degree  in  the  evening.  The  sweats  are  acid,  and  the  skin 
is  often  covered  by  a  fine  red  or  white  rash.  The  perspiration  is  profuse, 
and  of  an  acid  odor.  It  varies  in  amount  and  is  most  profuse  when  the 
pain  is  greatest.  It  is  said  that  the  odor  is  so  strong  and  so  characteristic 
that  frequently  the  diagnosis  can  be  made  from  that  alone.  The  sweats 
are  not  weakening,  but  though  unpleasant  to  the  patient,  afford  him  great 
relief. 

The  arthritis,  or  inflammation  of  the  joints,  is  marked  by  swelling, 
redness,  pain  and  heat.  Pain  in  a  joint  marks  the  onset  of  the  attack,  it 
swells  and  reddens  and  the  effect  may  spread  from  one  joint  to  another, 
or  remain  localized  at  one  joint.  The  joints  of  the  spine  and  the  sym- 
physis  pubes  may  be  attacked,  but  the  toes  are  rarely  invaded.  I  had  a 
case  in  which  every  joint  of  the  body  was  attacked.  The  person  was 
practically  immovable.  Every  articulation  of  the  spine,  everything  but 
the  lower  jaw  was  attacked  by  the  arthritis.  The  kidneys  were  very  bad. 
the  arms  were  drawn  at  the  elbows,  and  the  knees  were  drawn  up  to  a 
right  angle.  There  was  great  pain,  perspiration,  and  on  the  whole  it  was 
very  distressing.  The  lower  jaw  usually  escapes,  although  I  have  seen 
several  cases  in  which  the  lower  jaw  was  attacked. 

The  pain  is  excruciating:  much  increased  upon  movement.  It  begins 
as  a  sore  feeling  and  may  become  throbbing.  It  very  gradually  disap- 
pears, leaving  a  bruised  feeling  in  the  joint.  The  color  of  the  swollen 
joint  is  red  or  pink,  and  feels  warmer  than  the  surrounding  part. 

The  joints  most  affected  are  the  knees,  ankles,  shoulders,  wrists,  and 
elbows,  i.  e.,  the  larger  joints. 

Besides  the  fever,  sweats  and  arthritis,  there  are  various  symptoms. 


RHEUMATISM.  259 

You  will  notice  here  a  similarity  between  Rheumatic  fever  and  other 
specific  fevers.  An  attack  comes  on  much  in  the  manner  of  any  acute 
specific  fever.  There  is  chilliness,  malaise  and  general  debility;  sore 
throat,  aching  of  limbs  and  trunk,  flying  pains  in  the  joints  are  noted 
The  patient  lies  stretched  upon  his  back,  carefully  arranged  that  every 
joint  may  be  guarded;  the  complexion  is  sallow,  and  the  cheeks  flushed. 
Thirst,  lack  of  appetite,  frequent,  weak  pulse  and  slightly  accelerated 
respiration  are  all  present.  The  reaction  of  the  urine  is  acid,  it  is  scanty 
and  high  colored. 

The  joint  symptoms  are  transient,  usually,  passing  quickly  from  one 
joint  to  another,  those  sore  one  day  being  nearly  well  the  next,  while  still 
others  have  been  invaded.  The  tongue  is  coated  with  a  moist  white  fur. 
The  tongue  is  sometimes  coated  brown,  or  is  dry  and  cracked.  Dyspepsia 
and  bowel  disturbances  occur.  There  may  be  diarrhoea  or  constipation. 

The  urine  is  scanty,  high  colored,  strongly  acid  and  contains  a 
quantity  of  urates  and  uric  acid,  which  are  deposited  as  a  thick  sediment 
upon  cooling.  Delirium  and  stupor  may  arise,  but  are  rare.  Sleep  is 
either  prevented  or  much  broken  by  the  severe  pain.  The  patient's  mind 
is  much  disturbed  over  his  condition,  particularly  if  he  has  had  previous 
attacks.  I  have  a  case  of  a  little  girl  in  which  the  disease  began  with  a 
sore  throat.  Both  arms  and  both  limbs  are  affected,  and  }he  right  hip 
has  been  drawn  out  toy  the  disease.  She  has  been  affected  this  way  for 
five  or  six  years.  In  all  respects  the  bodily  health  is  excellent.  The 
'kidneys  are  in  a  healthy  condition.  The  urine  is  frequently  analyzed,  and 
only  in  case  of  cold  does  the  urine  show  a  departure  from  the  normal. 
She  is  fat  and  has  splendid  general  health.  This  shows  what  severe  cases 
of  specific  disease  may  exist  in  which  the  general  health  will  be  good. 
This  is  something  that  I  have  wondered  at,  and  something  which  I  think 
you  will  notice. 

Course,  Duration  and  Terminations: — Children  and  old  people  are 
rarely  attacked;  the  majority  of  cases  occuring  between  the  ages  of 
fifteen  and  forty.  Men  are  more  liable  to  it  than  women,  probably  be- 
cause they  are  more  exposed  to  conditions  of  the  climate.  Robust  per- 
sons are  more  frequently  victims  than  are  debilitated  ones.  The  disease 
is  more  common  in  the  spring  and  winter  seasons,  and  is  observed  in  all 
climates,  though  most  frequently  in  temperate  ones. 

The  course  does  not  follow  a  regular  cycle,  but  is  variable.  The 
attacks  may  pass  off  in  ten  or  twelve  days,  or  may  worry  the  sufferer  for 
many  weeks,  finally  passing  into  a  more  or  less  chronic  form. 

Convalescence  is  as  a  rule  tedious,  may  be  accompanied  by  desqua- 
mation  of  the  hands  and  feet,  or  of  the  body  generally,  and  is  frequently 
followed,  if  not  by  more  severe  sequelae,  by  pain  and  weakness  in  the 
joints.  The  remote  effects  of  the  disease  frequently  persist  during  the 


260  CHRONIC   ARTICULAR   RHEUMATISM. 

rest  of  the  life,  and  are  sometimes  considered  of  more  consequence  than 
the  original  attack.  Such  are  chronic  arthritis;  heart  disease,  especially 
valvular;  disease  of  the  lungs,  brain,  kidneys,  or  vascular  system. 

Complications: — Various  complications  arise  in  the  course  of  the  acute 
attack;  rendering  it  more  serious  and  more  difficult  to  deal  with.  Or- 
ganic heart  disease  is  most  common,  fifty  per  cent  being  the  estimate. 
It  is  said  that  children  and  youths  seldom  escape  it.  Its  presence  is  more 
common  in  severe  attacks,  women  seeming  to  be  more  subject  to  it  than 
men.  If  the  case  is  neglected,  heart  symptoms  are  more  likely  to 
appear. 

Complications  of  diseases  of  the  lungs  are  likely  to  occur  and  are 
responsible  for  death  in  a  large  proportion  of  the  fatal  cases.  Such  are 
pneumonia,  pleuro-pneumonia,  pleurisy,  bronchitis,  and  pulmonary  bron- 
chitis. Other  complications  are  renal,  serous  inflammation,  gout  and 
scarlatina. 

Diagnosis: — The  diagnosis  is  usually  made  without  difficulty,  but  is 
often  rendered  a  matter  of  great  difficulty  by  the  tendency  manifest,  in 
the  period  of  invasion,  to  resemble  in  symptoms  the  acute  specific  fevers. 
The  diagnosis  rests  upon  the  family  history,  the  history  of  the  attack,  the 
pain  and  tenderness  of  the  joints,  the  moving  about  of  the  joint  symp- 
toms from  joint  to  joint,  and  the  acid  sweats. 

Prognosis: — As  regards  death  is  good,  only  about  four  per  cent,  of 
the  cases  being  lost.  But  as  regards  succeeding  health,  it  is  described 
as  most  uncertain,  owing  to  the  variety  of  complications,  and  the  uncer- 
tain course  of  the  disease.  Under  Osteopathic  practice  the  prognosis  is 
good  for  Acute  Articular  Rheumatism.  It  runs  a  mild  course  in  children 
and  old  persons/  One  must  be  guarded  in  prognosis  in  cases  of  patients 
who  have  cardiac  or  lung  symptoms. 


LECTURE  VII. 

I  wish  to  call  your  attention  to  a  couple  of  points  in  regard  to  Acute 
Rheumatism,  or  Rheumatic  Fever.  That  is,  the  higher  the  fever,  and 
the  more  the  pain  shifts  about  from  joint  to  joint,  the  more  liable  the 
fever  is  to  go  to  the  heart.  There  is  greater  danger  then  of  it  attacking 
the  heart.  The  other  one  Is  that  as  long  as  the  alkalinity  of  the  urine  is 
retained,  the  heart  is  not  so  liable  to  be  attacked. 

Chronic  Articular  Rheumatism  is  a  painful  inflammation  of  one  or 
more  joints,  running  a  chronic  course.  Two  forms  are  described  by 
Raue;  one  in  which  some  single  joint  remains  chronically  stiff  and  pain- 
ful; the  bones  crepitate  at  the  joint  upon  motion  being  made  by  the 


CHRONIC   ARTICULAR  RHEUMATISM.  261 

operator;  the  joint  may  be  swollen,  or  the  swelling  may  be  lacking,  or 
only  apparent,  through  the  atrophy  of  the  surrounding  muscles. 

The  second  form  is  merely  repeated  attacks  of  rheumatism.  The 
patient  is  very  sensitive  to  changes  in  the  weather,  and  can  ofcen  foretell 
them  by  pains  in  his  affected  joints.  This  form  is  often  complicated  by 
rheumatic  neuralgia  or  paralysis. 

Aetiology: — The  causes  are  mainly  the  same  as  for  the  acute  form; 
heredity,  exposure,  mental  depression,  poverty  and  physical  exhaustion. 
The  disease  attacks  mostly  persons  in  middle  life  or  in  advanced  age. 

Pathology: — The  ligaments  and  synovial  membranes  are  thickened, 
enlarging  the  joint;  the  bones  have  become  spongiform  at  the  cartilagin- 
ous ends,  and  the  synovial  fluid  is  turbid.  Very  commonly  the  joints  are 
enlarged  and  deformed.  There  is  hyperaemia  and  effusion  in  the  tissues 
about  the  joint. 

While  the  disease  in  many  cases  is  the  result  of  the  acute  form,  it 
may  attack  one  independently  of  previous  illness.  Quain  states  that  in 
some  instances,  one  member  of  a  family  is  affected  by  the  chronic  form, 
while  brothers  and  sisters  suffer  from  acute  rheumatism. 

Symptoms: — The  most  marked  symptom  is  pain  and  stiffness  of  cer- 
tain joints,  aggravated  by  bad  weather,  and  becoming  most  severe  at 
night.  The  affected  joints  are  dry  and  stiff,  and  crepitate  upon  move- 
ment. Rubbing  and  exposure  of  the  joint  to  cold  atmosphere  lessen  the 
pain,  but  increase  of  warmth  aggravates  it. 

This  form  of  Rheumatism  varies  much  with  individuals,  some  are 
affected  with  stiffness  and  pain  in  some  single  joint.  The  joint  does  not 
seem  to  have  undergone  structural  change,  and  the  patient  may  have 
good  general  health,  leading  an  active  and  vigorous  life.  Other  cases 
present  more  severe  symptoms.  The  pain  in  the  joint  is  greater,  ana- 
tomical changes  have  taken  place  in  it,  and  it  is  red,  painful  and  swollen. 
There  are  repeated  attacks  of  sub-acute  rheumatism. 

Still  other  cases  present  more  marked  symptoms  of  pain,  swelling, 
etc.  The  changes  in  the  joint  are  marked,  the  attacks  are  so  frequent 
that  the  patient  is  in  almost  constant  pain.  The  joints  are  often  anky- 
losed  or  dislocated.  This  disease  often  leads  to  permanent  disability,  but 
deaths  from  the  disease  directly  are  rare. 

Heart  disease,  as  in  the  acute  form,  is  a  frequent  complication.  Dys- 
pepsia, and  the  formation  of  renal  calculi  often  occur. 

The  Prognosis  under  Osteopathic  treatment  is  good.  In  all  cases  re- 
lief can  be  given,  and  in  a  certain  number  entire  relief  from  the  symp- 
toms is  obtained.  Medical  prognosis  for  cure  is  very  unfavorable. 

MUSCULAR  RHEUMATISM:— This  form  of  Rheumatism  differs  consid- 
erably from  the  other  forms  described,  on  account  of  the  different  re- 
gions of  the  body  in.  which  it  settles,  attacking  muscles,  tendons,  peri- 


262  CHRONIC    ARTICULAR   RHEUMATISM. 

osteum,  neurilemma,  fascia,  and  other  fibrous  structures,  but  never  joints. 
It  shows  a  tendency  to  attack  certain  groups  of  muscles,  causing  varie- 
ties of  Rheumatism,  to  which  specific  names  have  been  given,  e.  g., 
Lumbago,  Pleurodynia,  Cephalodynia,  etc.  It  is  frequently  associated 
with  other  forms.  This  disease  is  characterized  by  pain  and  spasm  in 
the  part  affected,  and  by  some  fever. 

Aetiology: — A  rheumatic  diathesis  is  said  to  be  the  chief  predisposing 
cause.  It  attacks  one  at  any  age,  and  of  either  sex.  Exposure  to  cold, 
particularly  to  a  draft  upon  a  muscular  part;  strain  of  the  muscles  or 
ligaments,  are  the  chief  causes  of  an  attack. 

Raue  describes  the  pain  of  an  attack  of-  muscular  rheumatism  as, 
"tearing,  shooting,  stitching,  screwing,  burning;  sometimes  aggravated 
and  sometimes  relieved  by  motion,  rest,  cold  or  warm  application,  etc." 
Little  is  known  as  to  the  pathology  of  the  disease.  Sometimes  fibrous 
growths  are  formed  in  the  muscles,  and  the  peripheral  nerves  are  grown 
together,  but  usually  there  is  no  change  discoverable  in  the  muscular 
structures.  Swelling  and  redness  may  be  present  or  lacking. 

Symptoms  are  slight  fever,  sore  throat,  pain  in  the  muscles,  which  be- 
comes severe  and  spasmodic.  The  patient  assumes  characteristic  atti- 
tudes to  give  ease  to  the  parts.  The  tongue  is  furred,  appetite  is  poor, 
constipation  is  present,  also  general  malaise.  Most  of  these  symptoms 
may  be  wanting  in  any  given  case. 

This  Rheumatism  is  not  of  long  duration  in  many  cases.  It  may 
disappear  in  a  few  days  or  weeks,  or  may  remain  as  a  chronic  ailment, 
affecting  the  muscles  of  a  particular  part.  It  readily  yields  to  Ostco- 
pathic  treatment. 

The  chief  varieties  are  Rheumatic  Torticollis  (stiff  neck)  ;  affects  the 
muscles,  or  the  sterno-mastoid,  drawing  the  head  to  one  side,  (wry 
neck). 

Lumbago,  affecting  chiefly  elderly  persons,  coming  on  suddenly ;  the 
patient,  stooping  over,  finds  himself  unable  to  rise.  It  affects  the  lum- 
bo-dorsal  fascia,  the  erectors  spinae,  and  smaller  lumbar  muscles.  I 
remember  one  case  of  this  disease  in  particular.  I  was  called  early  one 
morning  to  go  to  see  a  lady  who  had  been  sitting  upon  a  chair  and  bending 
over  her  trunk,  and  when  she  went  to  arise  she  could  not  get  up.  When 
I  got  there  I  first  relaxed  the  muscles  aJl  along  the  lumbar  region  as 
best  I  could  with  her  sitting  upon  the  chair.  She  was  put  in  bed  and 
I  soon  got  the  muscles  all  loosened.  She  was  soon  all  right  again,  was 
about  that  day.  I  did  not  hear  of  her  being  troubled  afterward, 
although  I  lived  in  that  neighborhood  for  some  time. 

Cephalodynia,  attacking  the  frontal,  occipital,  temporal  muscle,  the 
galea  capitis,  or  periosteum  of  the  skull. 


TREATMENT   OF    RHEUMATISM.  263 

Dorsodynia,  of  the  muscles  of  the  upper  part  of  the  back  and  shoul- 
ders. 

Pleurodynia,  of  the  fibro-muscular  structures  of  the  chest,  causing 
pain  in  the  side,  cough,  restrained  respiratory  movements ;  in  pectoral  and 
intercostal  muscles. 

*TREATMENT: — Osteopathic  treatment  of  Rheumatism  must  be  persis- 
tent but  not  severe.  There  is  danger  in  Acute  Rheumatism  of  setting  up 
fresh  inflammation  and  driving  the  disease  to  the  heart,  if  too  severe  treat- 
ments are  given.  Hence  use  great  care.  One  should  not  treat  too  often  or 
too  long,  especially  at  the  beginning  of  treatment.  Three  times  per 
week  is  sufficiently  often.  Length  of  treatment  should  vary  from  ten  to 
fifteen  minutes,  according  to  the  case. 

Too  frequent  and  prolonged  treatments,  as  well  as  too  severe  hand- 
ling are  especially  apt  to  irritate  and  do  harm  in  Rheumatism,  because 
of  the  soreness  and  pain  that  naturally  accompany  the  complaint. 

In  any  case  of  Rheumatism,  the  Osteopath  must  give  especial  attention 
to  stimulation  of  the  kidneys.  He  must  also  thoroughly  treat  the  liver 
and  bowels,  stimulate  lung  action  and  cutaneous  circulation,  all  with  a 
view  of  removing  the  acid  from  the  system.  The  liver  is  said  to  be 
frequently  enlarged  in  Rheumatism. 

Dr.  Harry  Still  always  has  good  success  in  treating  rheumatism,  and' 
his  treatment  upon  the  kidneys  is  invariably  this  already  described  to 
you  as  stimulation  of  the  kidneys,  from  the  sixth  dorsal  to  the  second 
lumbar.  Your  work  upon  the  liver  and  bowels  is  for  the  purpose  of 
eradicating  the  poison  from  the  system.  You  must  also  stimulate  the 
twelfth  dorsal  and  upper  lumbar.  You  know  how  to  stimulate  the  lungs 
from  the  second  to  the  seventh  dorsal  on  each  side,  also  stimulate  the 
second  dorsal  and  fifth  lumbar,  centers  for  the  superficial  fascia.  A 
general  spinal  treatment  is  given,  and  bathing  and  as  much  active  exer- 
cise as  the  patient  can  take  are  good. 

The  treatment  then  for  the  liver,  over  the  ribs  from  the  eighth  to 
the  twelfth;  kidneys,  sixth  dorsal  to  the  second  lumbar,  also  the  twelfth 
dorsal  and  the  upper  lumbar;  for  the  lungs,  second  to  the  seventh  dorsal 
on  each  side ;  for  the  fascia,  second  dorsal  and  fifth  lumbar ;  add  to  that, 
treatment  to  the  superior  cervical  ganglion  of  the  sympathetic,  reaching 
the  center  for  the  medulla. 

I  have  seen  Dr.  Harry  Still  take  a  case  of  Rheumatism  and  for  the 
first  work  do  nothing  but  stimulate  the  bowels,  kidneys  and  liver,  and 
he  would  not  go  any  further.  I  have  often  wondered  why  he  should 
give  such  short  treatments,  but  he  is  very  successful  in  treating  Rheu- 
matism. The  treatments  are  new  to  the  patient,  and  this  is  all  that  he 


*See  Appendix  3. 


264  TREATMENT   OF   RHEUMATISM. 

can  stand.  You  must  gradually  extend  your  treatment  to  other  parts  of 
the  body,  since  in  the  various  forms  of  Rheumatism,  the  digestive  and 
circulatory  systems  may  be  deranged,  the  heart  and  lungs,  kidneys,  and 
blood  all  undergo  pathological  alterations,  and  even  the  brain  may  be 
affected.  The  Osteopath  must  keep  close  watch  upon  the  condition,  and 
by  combining  thorough  general  and  spinal  treatment  with  the  specific 
measures  he  employs,  keep  the  system  and  its  special  parts  and  organs 
well  stimulated  and  sustained.  He  may  thus  prevent  or  repair  these  path- 
ological changes,  aborting  the  attack,  or  giving  grateful  relief. 

In  the  articular  forms,  the  object  of  treatment  is  to  spread  the  joint 
and  give  free  access  of  blood  and  nerve  flow.  There  are  particular  ways.  - 
It  is  well  to  work  the  arm  up  and  around.  But  it  does  not  reach  as  well 
as  a  particular  move,  taking  the  arm  of  the  patient  in  one  hand  I  double 
the  other  hand  and  place  it  in  the  axilla.  I  then  push  the  arm  of  the 
patient  down  close  to  the  side;  that  springs  the  shoulder  joint,  allowing 
the  articular  nerves  and  vessels  free  action.  If  it  be  in  the  spine,  this 
movement  of  traction  that  I  have  shown  frequently  is  good,  or  with  the 
patient  sitting  with  the  hips  held  down,  while  you  reach  down  and  lift  at 
various  points  along  the  spine,  thus  spreading.  For  the  knee  and  ankle, 
you  can  have  someone  hold  under  the  shoulder  while  you  pull,  spreading 
.the  joints  of  the  knee  and  ankle.  Another  way  that  I  have  for  treating 
the  knee  is  to  place  the  foot  of  the  patient  between  my  knees  and  to 
work  in  the  popliteal  space,  holding  the  knee  and  spreading  the  ham- 
string muscles.  Another  very  good  way  is  to  have  the  patient  sitting 
upon  a  chair,  place  your  knee  under  that  of  the  patient  so  that  his  pop- 
liteal space  rests  upon  your  knee,  and  spread  the  joint  by  pushing  the 
leg  downward.  As  to  the  wrist  and  fingers,  you  can  by  holding  the 
forearm  in  one  hand,  spread  the  wrist  joint  and  the  fingers  by  traction. 
At  the  elbow  I  have  the.  forearm  semi-flexed  upon  the  arm,  that 
releases  the  olecrannon  process  and  I  can  spread  the  joint  by  traction 
at  the  bent  elbow.  This  motion  will  apply,  I  think,  to  all  of  the  joints 
of  the  body,  so  that  you  will  have  no  difficulty. 

When  there  is  motion  in  the  joint  and  the  synovial  membrane  is  not 
destroyed,  the  chances  of  restoring  it  are  good.  You  cannot  tell  How 
much  of  the  joint  has  been  destroyed.  You  can  only  tell  by  general 
symptoms,  by  the  amount  of  motion  and  the  amount  of  pain,  judging 
from  these  that  the  synovial  membrane  has  not  been  destroyed.  Then 
you  have  a  great  deal  better  success  than  if  the  membrane  has  beer, 
destroyed.  Spreading,  as  I  have  said,  renews  blood  and  nerve  supply 
and  absorbs  deposits,  but  it  will  take  many  months.  You  must  have  the 
patients  treating  for  month  after  month.  A  great  many  people  do  not 
have  the  patience,  even  if  they  possess  the  means,  to  continue  the  treat- 
ment long  enough  to  get  the  results.  If  people  possessed  the  patience 


TREATMENT   OF   RHEUMATISM.  265 

to  continue  the  treatment  a  sufficient  length  of  time,  we  could  do  so 
much  more  good  than  we  can  under  other  conditions. 

In  Acute  Rheumatism  great  care  must  be  taken  in  spreading,  on 
account  of  the  pain.  The  same  is  true  to  a  considerable  extent  in  the 
chronic  forms.  You  must  gradually  accustom  the  patient  to  the  treat- 
ment so  that  he  can  stand  a  great  deal  more. 

In  Muscular  Rheumatism,  the  treatment  must  be  directed  to  stretch- 
ing and  thoroughly  kneading  the  affected  muscle,  tendon  or  joint.  I  lay 
special  stress  upon  stretching  the  muscles.  If  you  have,  say  the  biceps 
muscles  of  the  arm  affected,  I  would  adopt  some  such  motion  as  this: 
push  the  arm  out  straight  and  back,  the  idea  being  to  increase  the  dis- 
tance between  the  bony  attachments,  so  as  to  stretch  the  muscles.  Get 
the  best  way  to  stretch  and  elongate  the  muscle  itself.  Owing  to  the 
elasticity  of  the  muscles  they  may  be  stretched,  allowing  free  flow  of 
blood  through  them.  You  can  also  knead  some,  and  you  can  prescribe 
baths.  A  salt  rub  is  good.  Massage  treatment  will  not  be  a  bad  thing 
with  the  idea  of  loosening  the  blood  flow,  taking  away  the  congested 
condition;  but  we  do  not  depend  much  upon  this  massage,  the  principal 
treatment  being  to  knead  the  muscles  and  to  stretch  them.  I  believe 
there  is  a  theory  that  the  specific  poison  is  retained  in  the  diseased  part, 
so  that  by  throwing  more  blood  to  the  part  and  by  stimulating  that 
region  it  helps  to  carry  away  and  throw  off  the  poison. 

The  Osteopath  must  always  trace  the  nerve  supply  of  the  affected 
parts  and  look  for  lesion  to  the  nerve  or  centers.  In  sciatic  rheumatism 
and  in  rheumatism  of  the  arms,  I  have  found  distinct  lesions  along  the 
spine..  Within  the  last  month  I  have  had  four  different  cases  in  which 
there  was  rheumatism  in  one  or  both  arms,  and  in  each  one  of  these 
cases  I  have  found  some  slip  of  the  vertebras  in  the  upper  dorsal  region, 
this  being  the  region  that  seemed  to  be  most  involved,  while  in  sciatica 
and  in'  lumbago  you  will  often  find  slips  or  lesions  along  the  spine.  It 
is  a  part  of  our  system,  this  finding  of  special  lesions.  When  you  find 
such  lesions,  although  you  may  not  be  able  to  directly  connect  them  with 
the  disease,  you  must  be  able  to  trace  indirectly  in  this  way. 

In  lumbago  there  is  a  direct  lesion  to  the  nerves  of  the  lower  spinal 
muscles.  I  have  found  that  the  best  way  to  treat  this  is  with  the  patient 
sitting  upon  a  chair.  This  is  the  same  treatment  that  I  have  shown  for 
other  things,  that  is  for  stretching  the  joints  of  the  spine.  I  work  here 
particularly  along  the  lumbar  region,  lifting  and  turning  as  I  go,  with  the 
idea  of  loosening  these  muscles  and  correcting  any  slip  which  may  have 
occurred. 

Besides  the  points  already  mentioned,  heat  and  rest  arc  valuable 
adjuncts  to  the  Osteopathic  treatment. 


266  INFLUENZA,  CATARRH  AND  COLD. 

Acute: — In  the  fevered  stage  of  Rheumatism,  the  cold  baths,  cold 
pack,  and  sponging  with  tepid  water  are  beneficial. 

The  patient  should  be  placed  in  bed  between  blankets,  which  absorb 
perspiration  and  prevent  the  chill  of  damp  linen.  Rest  for  the  affected 
joint  is  supplied  by  wrapping  it  in  cotton,  wool  or  other  soft,  warm 
material.  Warm  fomentations  give  relief  when  applied  to  the  joint. 
As  far  as  possible  we  move  the  joint,  especially  in  the  chronic  forms. 
The  joint  is  placed  at  rest  entirely  in  this  acute  form,  but  if  it  is  kept 
there  too  long  it  may  become  ankylosed.  If  you  keep  up  motion  to  the 
greatest  extent  possible  you  will  be  able  to  get  better  results.  I  have 
not  known  of  a  case  which  was  followed  out  by  Osteopathic  treatment 
where  the  joint  was  left  stiff.  It  is  a  matter  of  judgment  as  to  how  far 
to  work  the  joint. 

In  chronic  forms  warm  clothing  and  housing,  protection  from  climate, 
relief  from  toil  and  muscular  exertion,  Turkish  baths,  warm  or  hot  fo- 
mentations applied  to  the  joints,  followed  by  vigorous  rubbing,  are  valu- 
able aids  to  Osteopathic  treatment. 

In  muscular  rheumatism  the  same  general  plan  of  treatment  may  be 
followed. 

It  should  be  borne  in  mind  that  these  various  adjuncts  may  not  be 
necessary  except  in  severe  and  stubborn  cases.  If  the  simple  Osteopathic 
treatment  is  sufficient  you  will  not  need  to  be  bothered  with  these  other 
things. 


LECTURE  VIII. 

Influenza,  Catarrh  and  Colds: — These  three  maladies  are  somewhat 
similar  in  pathology.  They  frequently  are  presented  to  the  Osteopath  for 
treatment,  and  such  treatment  is,  as  a  rule,  in  the  highest  degree  successful. 

The  treatment  for  influenza,  and  for  the  condition  commonly  known 
as  cold,  are  almost  identical,  while  that  for  catarrh  is,  as  far  as  it  goes, 
similar.  Hence,  these  subjects  may  be  conveniently  considered  in  the  same 
lecture.  The  fact  that  all  may  depend  upon  the  same  age'ncy  for  their 
production,  at  least  to  some  extent,  namely  exposure,  and  the  fact  that  in 
all  the  main  pathological  facts  are  the  congestion  of  the  blood  in  certain 
parts  of  the  body,  the  tightening  of  the  muscles  and  ligaments,  and  the 
aberration  of  nerve  function  consequent  to  these  conditions,  makes  them 
especially  interesting  to  the  Osteopath,  and  especially  amenable  to  his 
treatment. 

Influenza,  commonly  known  as  La  Grippe,  called  also  Catarrhal  Fever 
and  Epidemic  Catarrh,  is  described  as  an  acute,  infectious,  epidemic  dis- 


INFLUENZA,  CATARRH  AND  COLDS.  267 

ease,  marked  by  febrile  symptoms,  and  usually  complicated  with  other 
serious  affections,  being  followed  by  sequelae  that  are  frequently  distressing 
and  severe  in  a  marked  degree,  such  as  progressive  muscular  atrophy, 
various  forms  of  paralysis  and  spinal  trouble,  etc.  There  is  one  patient 
here  at  present  suffering  from  Locomotor  Ataxia  and  progressive  muscular 
atrophy.  He  tells  me. that -he  had  four  or  five  different  attacks  of  in- 
fluenza. I  think  that  his  disease  may  have  developed  from  these  repeated 
attacks  of  influenza  with  the  attending  nervous  symptoms.  It  is  not  at  all 
surprising  that  such  serious  results  should  follow,  when  you  come  to  con- 
sider that  these  nervous  disturbances  reach  far  enough  to  alter  the  state 
of  nerve  centers  to  a  very  marked  degree. 

As  a  rule  this  distressing  malady  occurs  epidemically  on  a  grand 
scale,  though  it  may  also  occur  epidemically,  and  occasionally  sporadically. 
Usually  vast  areas,  such  as  whole  countries,  are  successively  invaded  by 
the  epidemic.  Epidemics  are  recorded  as  early  as  1729. 

Its  manifestations  are  varied,  different  epidemics  seeming  to  possess 
different  marked  characteristics,  but  three  different  general  forms  have 
been  described : 

(1)  Simple,  without  serious  complications.     (Catarrhal.)     This  form 
attacks  particularly  the  membranes  of  the  respiratory  tract. 

(2)  Thoracic,    involving  the  thoracic  viscera,  and  complicated  with 
such  affections  as  pneumonia,  bronchitis,  etc. 

(3)  Abdominal,  or  Gastro-Intestinal,  affecting  the  digestive  organs. 
I  will  mention  one   fact  here,  lest  I  forget  it  when  speaking  of  colds.     I 
have  known  people  to  have  a  severe  attack  of  intestinal  cramping,  accom- 
panied with  constipation  or  diarrhoea  and  severe   colic — symptoms  arising 
from  what  I  believe  to  be  taking  cold  in  the  abdomen.     They  in  some 
way  get   the  abdomen  exposed,  perhaps  by  a  change  of  clothing,   which 
would  j:ause  the  cold  to  settle  in  the  abdomen  without  necessarily  being 
felt  elsewhere.     This,  I  think,  will  be  a  valuable  suggestion  to  you. 

(4)  To  these  has  been  fittingly  added  the  Neural  or   Cerebral  type, 
attacking  the  nervous  system,  often  simulating  the  clinical  course  of  Ty- 
phoid fever,  as  does  sometimes  the  Intestinal  type. 

It  is  stated  that  these  various  types  may  all  be  seen  in  the  same  family 
in  which  several  members  may  be  suffering. 

Clinical  Features: — The  onset  is,  as  a  rule,  very  sudden.  The  patient 
may  note  the  first  symptoms  upon  rising  from  bed  in  the  morning,  upon 
rising  after  sitting,  or  when  about  his  daily  tasks,  having  a  few  moments 
previously  felt  entirely  well.  It  usually  manifests  itself  first  by  a  chill, 
followed  by  a  fever,  loss  of  appetite,  headache,  lassitude,  aching  and  sore- 
ness of  the  back,  limbs,  and  muscles,  profound  mental  and  physical  de- 
pression, catarrhal  inflammation  of  the  nasal  mucous  membrane,  etc.  This 
malady  may  affect  persons  of  any  age,  sex,  or  occupation.  Pulse  slow ; 


268  HTPLUENZA,   CATARRH   AND   COLDS. 

constipation;   temperature  irregular  to  high;  urine   scanty  and  high  col- 
ored, or  profuse  and  light  colored. 

Catarrhal  Type: — Dryness  of  the  nostrils,  sore  throat,  sneezing,  water- 
ing of  the  eyes,  difficulty  of  swallowing  and  of  breathing,  and  pains  in  the 
eyeballs  are  present.  These  symptoms  may  remit  during  the  day,  increas- 
ing at  night.  The  tongue  is  moist  and  coated  with  a  creamy  fur,  the 
pulse  is  frequent  (80-100).  Diarrhoea  is  often  a  symptom,  as  well  as  in- 
flammation of  the  ear. 

Thoracic  Type: — In  this  form,  in  addition  to  the  usual  symptoms,  are 
seen  pneumonia,  bronchitis,  pleuritis,  quinzy,  and  infiltration  of  the  lung. 
All  the  prominent  symptoms  are  concerned  with  the  thoracic  viscera.  A 
peculiarity  of  the  Bronchitis  is  the  general  inflated  condition  of  the  lung, 
which,  instead  of  collapsing  upon  opening  the  thoracic  cavity,  protrudes 
from  the  aperature. 

Gastro-Intestinal  Type: — Soreness  of  the  abdomen,  biliousness,  nau- , 
sea,   vomiting,   sometimes  jaundice,   diarrhoea,  etc.,   are  prominent  symp- 
toms, in  addition  to  the  general  symptoms  named  above. 

Cerebral  Type: — The  nervous  symptoms  predominate.  Headache,  de- 
lirium, tinnitus  aurium,  muscular  twitching  and  hyperaesthesia  are  all 
noted. 

Influenza  is  of  variable  duration  in  length  of  time  of  the  attack.  It 
may  disappear  in  forty-eight  hours,  or  it  may  remain  acute  for  several 
weeks.  Often  it  subsides  into  a  semi-chronic  state,  and  keeps  the  sufferer 
miserable  for  months.  It  seems  to  attack  the  weak  points  in  the  system, 
and  to  develop  latent  morbid  processes  already  present.  It  is  not  usually 
of  itself  fatal,  but  causes  death  in  a  fair  average  of  cases  through  some 
complication  or  sequel.  The  Bronchitis  of  Influenza  seems  to  be  the  most 
fatal. 

A  serious  feature  of  this  disease  is  the  sequelae  it  leaves.  The  mental 
and  physical  depression  often  persist  after  the  acute  attack.  Hypochondria, 
tuberculosis  and  paralysis  frequently  supervene.  The  poison  left  in  the 
system  has,  according  to  Gowers,  a  peculiar  liability  to  affect  the  nervous 
system.  Hence  the  nervous  sequelae,  both  from  their  nature  and  frequency, 
are  the  most  marked  of  the  after  effects.  Mental  dullness,  melancholia, 
and  delirium,  the  general  paralysis  of  the  insane;  hysteria,  cataleptoid  and 
epileptic  seizures ;  neuritis  and  affections  of  nerve  centers,  are  all  among 
nervous  sequelae  of  Influenza  noted  by  Gowers. 

Aetiology: — Little  is  known  definitely  concerning  the  cause  of  this 
disease.  Some  writers  have  suggested  an  atmospheric  influence,  as  well 
as  the  effect  of  bad  drainage  and  poor  sanitation,  as  being  the  cause.  It 
seems  probable  that  the  true  aetiological  factor  is  a  microbe  discovered 
by  Pfeiffer,  Kitasato  and  Canon  in  1892. 


INFLUENZA,  CATARRH  AND  COLDS.  269 

CATARRH: — Catarrh,  Coryza,  or  cold  in  the  head,  is  an  inflammation 
of  the  nasal  mucous  membranes,  with  increased  secretions  from  them. 

The  term  Catarrh  is  used  in  a  general  sense  in  describing  the  inflam- 
mation of  any  mucous  membrane  in  the  body.  Thus  there  is  Catarrh  of 
the  stomach,  Intestinal  Catarrh.  Catarrh  of  the  bladder,  etc.  The  term 
Coryza  is  usually  employed  to  designate  Catarrh  of  the  nasal  membranes. 

Symptoms  and  Aetiology: — Catarrh  is  brought  on  by  exposure,  by  too 
sudden  cooling  of  the  body  when  heated,  or  by  sudden  lowering  of  the 
temperature.  It  occurs  sporadically,  sometimes  epidemically,  and  one  at- 
tack predisposes  to  another.  It  is  sometimes  caused  by  inhalation  of  irri- 
tating gases,  such  as  chlorine,  etc.  It  is  stated  by  Raue  that  epidemics 
seem  to  depend,  upon  a  peculiar  unknown  condition  of  the  atmosphere, 
probably  deficiency  or  superabundance  of  ozone.  You  will  also  find  fre- 
quently that  the  contraction  of  muscles  has  drawn  the  vertebrae  out  of 
place.  This,  frequently,  has  been  found  to  be  the  case  by  our  practitioners, 
and  there  does  not  seem  to  be  any  reason  for  doubting  that  the  vertebrae 
may  be  drawn  out  of  place  by  contraction  of  the  muscles.  I  have  had 
cases  of  trouble  in  the  neck  where  the  vertebrae  were  displaced.  It  is  often 
the  second  or  third.  I  have  often  found  when  I  had  replaced  a  vertebra 
that  the  effect  of  a  cold  was  to  draw  it  out.  I  will  say  that  such  may  not 
be  the  case  except  where  there  has  been  a  previous  accident,  causing  a  dis- 
placement of  the  vertebra,  but  I  am  convinced  from  my  observation  that  a 
vertebra  may  be  drawn  out  by  overdue  contraction  of  a  muscle.  And  from 
the  standpoint  of  Osteopathy  this  disease  may  be  caused  by  some  faulty 
condition  in  the  -anatomy  of  the  neck,  contractions  of  the  deep  muscles,  or 
displacement  of  cervical  vertebrae,  usually  of  the  second  or  third,  which 
interferes  with  blood  and  nerve  supply  of  the  nasal  mucous  membrane  by 
shutting  down  upon  the  jugular  veins,  thus  preventing  venous  return,  or 
by  affecting  nerves  controlling  the  blood  flow,  thus  disarranging  it.  These 
conditions  either  weaken  the  membranes  and  leave  them  susceptible  to  the 
influence  of  the  ordinary  aetiological  factors,  or  they  cause  a  congested 
and  inflamed  condition  of  these  parts,  attended  with  the  increased  secre- 
tions characteristic  of  catarrh. 

The  Symptoms  are  chilliness,  headache,  indisposition,  sneezing,  dry- 
ness  of  the  nose  and  throat,  etc. 

The  inflammation  .extends  into  the  frontal  sinuses,  into  the  antra  of 
Highmore,  through  the  nasal  duct  to  the  lachrymal  sac,  causing  conjunc- 
tivitis, or  into  the  Eustachian  tubes,  affecting  the  ears.  The  inflammation 
may  also  extend  from  the  mucous  membrane  into  the  skin  of  the  nose, 
or  down  into  the  bronchi,  causing  lung  troubles. 

The  catarrh  is  described  as  serous,  mucous,  or  muco-purulent  accord- 
ing to  the  nature  of  the  secretion.  The  first  secretion  is  thin  and  watery, 


270  TREATMENT   OF    CATARRH,    COLDS   AND   INFLUENZA. 

the  second  is  thick,  a  copious  discharge  of  mucous ;  the  third  is  composed 
largely  of  leucocytes,  and  partakes  of  the  nature  of  pus. 

This  latter  discharge  may,  in  chronic  cases,  decompose  in  the  nasal 
cavities  or  in  the  sinuses  and  become  extremely  offensive. 

COLDS  : — A  cold,  regarded  by  some  writers  as  a  nervous  disturbance,  is 
usually  considered  as  a  congestion  of  the  blood  in  the  vessels  in  some  part 
or  parts  of  the 'body,  brought  on  by  exposure  in  some  form.  Coryza  is  a 
cold  in  the  head. 

Aetiology:— Cooled  surface  of  the  body  and  closed  pores  drives  the 
blood  inward,  increases  the  work  of  the  lungs,  and  causes  it  to  congest 
at  weak  spots;  exposure  to  the  cold  or  damp,  e.  g.,  getting  the  feet  wet, 
sudden  cooling  of  the  body  when  heated,  sitting  or  standing  in  a  draft, 
living  in  overheated  quarters,  sleeping  under  too  heavy  covers,  and  wear- 
ing of  too  warm  clothing,  thus  causing  the  body  to  become  tender,  are 
among  the  usual  causes  of  catching  cold.  I  have  known  people  who  were 
foolish  enough  to  suppose  that  by  keeping  in  doors  all  the  winter  they 
would  be  free  from  colds,  and  it  is  almost  invariably  the  case  that  they 
will  have  a  cold  much  of  the  time.  They  stay  in  warm  rooms  and  sleep 
under  too  warm  covering,  and  the  body  becomes  tender.  Coming  sud- 
denly from  very  cold  temperature  into  very  warm,  as  from  out  doors 
into  a  super-heated  room,  will  give  a  person  a  cold  as  quickly  as  to  go 
from  a  heated  room  out  into  the  cold.  The  system  is  not  always  able  to 
accommodate  itself  to  such  sudden  changes  of  temperature. 

Symptoms  are -similar  to  those  noted  in  Catarrh,  namely:  chilly  sensa- 
tions, discharge  from  the  nasal  mucous  membranes,  headache,  light  hem- 
orrhage from  the  nose,  soreness  and  stiffness  of  the  muscles,  etc. 

One  attack  predisposes  to  another.  The  patient  frequently  falls  into  a 
semi-chronic  condition,  continually  taking  more  cold  and  seldom  being 
without  one.  This  is  likely  to  happen  on  account  of  the  deranged  circula- 
tion, the  patient  frequently  breaking  out  into  a  perspiration  with  slight 
exertion,  this  being  followed  by  further  chilling  and  fresh  symptoms  of  a 
cold.  A  cold,  if  severe,  may  have  severe  complications;  pneumonia,  bron- 
chitis, influenza,  etc. 

Treatment,  (heat): — The  drinking  of  hot  lemonade,  hot  foot  baths, 
especially  upon  retiring,  or  wrapping  up  well  in  a  3ry  blanket  to  pro- 
.duce  copious  perspiration  are  usually  enough  to  reduce  a  cold  at  first. 
It  is  said  that  if  a  cold  is  treated  this  way  vigorously  within  the  first 
twenty-four  hours  you  can  reduce  it.  These  things  should  be  used  at 
night,  and  additional  clothing  should  be  put  on  next  day,  as  the  system 
is  weakened  from  perspiration,  and  care  should  be  taken  not  to  take 
more  cold.  Some  would  prescribe  dry  heat  instead  of  moist..  Heating 
of  the  feet  before  a  fire  is  a  good  thing,  and  does  not  open  the  pores  in 
the  way  that  hot  water  does,  so  if  it  is  in  day  time  when  you  cannot 


TREATMENT  OF  CATARRH.  271 

take  the  care  you  would  like,  this  application  of  dry  heat  is  perhaps  a 
good  remedy  at  first. 

Influenza: — I  give  the  patient  a  thorough  spinal  treatment.  I  had  a 
case  of  cold  to  treat  this  morning,  and  I  gave  the  same  treatment  that  I 
give  for  influenza.  With  the  patient  upon  the  face,  thoroughly  loosen 
all  the  muscles  and  thoroughly  stimulate  the  whole  spine.  The  theory 
you  already  know.  If  I  could  not  work  enough  with  the  patient  upon 
his  face  I  would  turn  him  over  and  thoroughly  stimulate  the  lungs,  kid- 
neys, liver  and  fascia  in  such  a  way  as  to  work  off  the  effects  of  the  dis- 
ease. That,  in  cold,  or  influenza,  is  the  particular  Osteopathic  treat- 
ment. For  the  lungs,  the  second  to  the  seventh  dorsal  vertebra ;  kid- 
neys, lower  splanchnics;  liver,  at  the  abdomen,  from  the  eighth  to  the 
twelfth  ribs  on  the  right  side,  raising  the  ribs,  working  in  the  right  and 
left  iliac  fossae  to  reach  the  hypogastric  plexuses,  and  deep  over  the 
solar  plexus.  Guard  against  the  possible  settling  of  a  cold  or  influenza 
at  these  points,  also  attend  to  the  fascia  at  the  second  dorsal  and  fifth 
lumbar.  That  is,  include  these  points  in  your  spinal  treatment. 

Should  the  influenza  have  settled  in  the  abdomen,  give  a  thorough 
abdominal  treatment,  embodying  the  points  already  given.  I  would  also 
give  an  ancma  in  such  a  case  to  relieve  the  bowels  of  fresh  congestion. 
I  would  treat  the  spine  especially  from  the  middle  dorsal  down,  and  all 
these  plexuses  of  nerves  through  the  abdomen. 

For  Cerebral  Influenza  I  would  look  particularly  for  ai,y  condition 
of  contraction  of  the  muscles  along  the  spine.  I  first  look  for  any  con- 
tractures  of  the  muscles  in  the  neck.  It  seems  to  me  from  my  experience 
there  is  always  a  contraction  of  the  muscles  of  the  neck  although  the 
cold  may  be  elsewhere.  It  may  be  settled  in  the  chest  or  some  other 
part  of  the  body,  but  there  will  almost  always  be  a  contraction  of  the 
muscles  of  the  neck.  I  do  not  know  that  I  ever  found  a  cold  where 
there  was  not  this  marked  condition  of  contraction  of  the  muscles. 
See  whether  or  not  there  be  any  displacement  of  the  vertebrae;  the  con- 
traction of  the  muscles  is  very  apt  to  bring  on  such  a  condition.  In  my 
experience  in  order  to  find  out  whether  or  not  there  is  displacement  of  a 
vertebra,  I  stand  behind  the  head  and  turn  it  from  side  to  side,  getting 
in  deep  to  find  if  there  be  any  displaced  vertebra.  In  several  cases  where 
I  knew  there  was  trouble  in  the  neck,  I  could  not  tell  by  standing  at 
the  side  where  the  vertebra  was  out.  When  you  are  working  on  a  patient 
in  bed,  bear  this  in  mind,  to  get  the  patient  in  such  a  position  that  you 
can  go  to  the  top  of  the  head.  When  there  are  these  cerebral  symptoms, 
and  the  trouble  is  especially  in  the  head,  you  must  treat  the  spine,  equal- 
izing the  circulation,  and  sending  the  blood  elsewhere. 

In  Catarrh,  as  well  as  in  cold,  we  would  first  thoroughly  loosen  the 
muscles  about  the  neck,  especially  about  the  sides  and  back  of  the  neck, 


272 


TREATMENT   OF    CATARRH. 


also  the  styloid  and  hyoid  muscles.  Take  the  muscles  which  are  at- 
tached to  the  styloid  process  and  thoroughly  relax  them.  A  good  treat- 
ment for  catarrh  is  to  hold  under  the  lower  jaw  and  have  the  patient 
spring  the  mouth  wide  open,  you  rub  the  muscles  well  on  each  side  and 
thoroughly  relax  them.  Stand  at  the  side  and  press  in  deeply  at  the 
styloid  process  with  the  idea  of  loosening  these  muscles  and  freeing  the 
flow  of  blood  through  the  carotid  artery.  Dr.  Harry  Still  uses  this  treat- 
ment in  almost  every  case,  (and  sometimes  almost  exclusively)  of 
catarrh  and  troubles  with  the  eyes  and  ears.  He  will  have  the  patient 
open  his  mouth  five  or  six  times.  Now  particularly  in  catarrh  you  will 
find  the  second  and  third  vertebrae  are  apt  to  be  deviated  to  one  side 
or  the  other.  We  treat  here  at  the  upper  part  of  the  neck,  and  reach 
the  superior  cervical  ganglion,  thus  influencing,  through  the  sympathetic 
plexus,  the  different  parts  of  the  brain,  and  through  these  nerves,  the 
sub-and  great  occipitals,  thus  reaching  the  medulla,  which  you  know 
contains  the  vaso-motor  center,  thus  influence  the  general  circulation  of 
the  body.  It  is  important  to  work  down  along  the  spine  to  get  the 
stimulating  effect  and  the  distribution  of  the  blood  flow.  Also  treat  all 
these  points  of  the  fifth  nerve,  at  the  supra-orbital,  the  infra  orbital  and 
the  mental  foramina.  Have  the  patient  open  the  mouth  wide,  push  the 
finger  into  the  glenoid  fossa,  and  have  the  patient  close  his  mouth,  that 
will  have  the  effect  of  loosening  the  ligaments,  and,  it  is  claimed,  affects 
the  fifth  nerve.  We  also  reach  the  fifth  nerve  through  its  connections 
sympathetically  by  working  upon  the  sub-and  great  occipital  nerves.  I 
also  in  addition  to  this  always  thrust  my  finger  behind  the  clavicles,  thus 
raising  the  clavicles  and  stimulating  the  flow  of  blood.  Another  treat- 
ment is  to  have  the  patient  lie  upon  his  back,  and  with  the  mouth  open, 
I  place  the  hnger  against  the  hard  palate  and  work  from  side  to  side, 
back  along  the  soft  palate,  uvula  and  pillars  of  the  fauces.. 

I  am  treating  a  case  at  present  in  which  the  tonsils  are  chronically 
enlarged  and  the  uvula  is  over  one  half  an  inch  in  length.  These  internal 
treatments  reach  that  condition  much  better  than  any  treatments  I  have 
been  able  to  give.  In  this  connection,  you  will  often  have  a  patient  with 
a  little  hacking  cough,  most  frequent  in  children;  if  you  will  look  into 
the  throat  you  will  find  that  the  condition  of  the  soft  palate  is  causing 
just  enough  irritation  to  keep  up  this  little  cough.  By  this  internal 
treatment,  and  by  treatment  in  the  neck  you  will  be  able  to  stop  the 
cough.  I  have  another  case  which  is  rather  peculiar,  in  which  the 
mucous  membrane  of  the  throat  is  congested.  There  is  an  irritation  of 
the  throat  which  is  dry  and  scales  off  in  great  dry  flakes,  sometimes 
blood  mixed  in  it.  It  is  peculiar  in  being  so  dry.  I  have  treated  the  case 
in  the  way  indicated  to  you,  especially  the  styloid  and  hyoid  muscles, 
quite  hard.  It  will  not  hurt  usually  to  work  hard,  but  that  you  can 


TREATMENT  OF   COLDS.  273 

determine  by  the  condition  of  your  pateient.  I  thoroughly  relaxed  in 
this  way,  and  the  lady  who  before  had  to  have  water  by  her  bed  at  night 
and  frequertly  during  the  day,  is  very  much  better..  Also  in  a  cold  wo 
treat  the  sides  of  the  nose,  working  from  the  lachrymal  duct  down.  It 
seems  to  stimulate  the  nerves  and  the  flow  of  blood,  freeing  the  mem- 
brane very  well.  We  can  free  very  nicely  by  working  down  the  nose  in 
this  way.  This  is  on  the  same  principle  that  our  mothers  used  to  grease 
our  noses  with  goose  grease.  For  a  stoppage  of  the  nostrils  and  dif- 
ficulty in  breathing,  here  is  a  motion  that  we  employ  with  very  good 
success.  It  is  best  to  have  a  pillow.  Lay  the  palm  of  the  hand  flat  on 
the  patient's  forehead,  press  down  hard  at  the  frontal  region,  and  bring 
a  great  deal  of  pressure  in  this  way.  The  nerve  connection  is  probably 
through  fibres  of  the  fifth.  A  great  many  cases  of  nostril  stoppage 
will  be  relieved  in  this  way.  Work  all  about  the  eyes  and  loosen  all 
about  the  face  to  relieve  the  congested  condition. 

Now  I  might  explain  to  you  my  particular  method  of  treating  a  cold. 
I  have  the  patient  lie  upon  the  back,  and  I  raise  all  the  ribs  and  stimu- 
late the  lungs  very  briskly,  on  either  side  from  the  second  to  the  sev- 
enth dorsal.  I  work  from  the  middle  dorsal  above  as  low  as  the  twelfth 
dorsal,  successively, 'having  my  hands  against  the  angles  of  the  ribs,  and 
raising  them  as  I  go  very  briskly  and  very  energetically.  This  is  a 
great  stimulation  of  the  lungs  as  well  as  of  the  circulation  throughout 
the  body.  I  then  bend  the  arm;  this  will  stretch  the  muscles  over  the 
chest  and  raise  the  upper  ribs,  then  I  raise  these  upper  ribs  by  pushing 
the  arm  up  and  working  under  the  clavicle. 

I  frequently  have  been  able,  by  this  treatment,  to  relieve  heavy  colds 
in  one  treatment.  If  you  can  always  do  that  you  will  be  very  fortunate. 
I  give  a  brisk  and  thorough  treatment  to  the  neck  as  well,  and  sometimes 
it  is  the  best  thing  you  can  do  for  the  patient  to  thoroughly  loosen  the 
neck. 

If  in  any  of  these  troubles  there  is  a  development  of  any  special 
symptoms,  you  must  attend  to  these  symptoms  at  once. 

Q.     Do  you  think  it  is  necessary  to  remove  the  tonsils? 

A.  It  is  often  done.  I  do  not  think  it  is  necessary  if  we  get  the  case 
in  time.  As  to  whether  it  is  ever  necessary,  I  presume  it  is.  Some- 
times they  grow  again  and  sometimes  they  do  not. 

Q.  Do  you  give  the  same  treatment  for  dry  catarrh  that  you  do 
for  moist  catarrh? 

A.    Yes,  sir. 

Q.  What  would  you  do  in  case  of  croup.  Could  you  give  immedi- 
ate relief? 

A.  I  should  treat  the  neck  thoroughly.  I  have  been  able  by 
treatment  to  give  immediate  relief.  I  would  work  all  about  the  throat 


274  CONSTIPATION. 

and  neck.  The  trouble  in  giving  treatment  for  croup  is  that  it  i£  gener- 
ally found  in  little  children  who  object  to  such  treatment.  Main  treat- 
ment should  be  directed  to  loosening  the  styloid  and  superior  hyoid 
muscles. 

Q.     Would  you  use  salt  water? 

A.     Yes,  sir,  that  is  very  good. 

Q.     What  would  you  do  in  membraneous  croup.'' 

A.  You  must  be  very  careful  in  cases  of  membraneous  croup. 
Cause  the  patient  to  throw  up.  Thrust  the  finger  down  the  throat  and 
get  the  membrane  in  that  way.  If  the  membrane  is  far  it  will  take 
very  prompt  action.  Thoroughly  treat  about  the  -throat  to  keep  the 
circulation  free  and  prevent  the  forming  of  the  membrane. 

Q.     In  catarrh  of  the  throat  would  you  give  internal  treatments? 

A.    Yes,  sir. 

Q.     How  often  would  you  treat  catarrh? 

A.     I  would  treat  it  three  times  a  week.     That  will  be  sufficient. 

Q.     \Vould  you  treat  internally  that  often? 

A.  No,  sir,  I  would  not  treat  internally  oftener  than  once  a  week, 
or  once  in  ten  days,  unless  in  severe  cases. 

In  regard  to  colds,  I  have  had  cases  where  the  cold  was  chronic  and 
the  condition  of  the  system  was  weakened,  in  which  I  got  good  results 
by  directing  the  patient  to  take  a  cold  bath  every  morning.  The  brisk 
lubbing  stimulates  the  circulation;  not  only  does  it  stimulate  the  circu- 
lation, but  it  has  a  good  effect  on  the  nervous  system,  stimulating  and 
strengthening  the  pores  of  the  skin  so  that  they  can  more  readily  open 
and  close  and  accommodate  themselves  to  changes  in  temperature. 


LECTURE    IX. 

CONSTIPATION. 

CONSTIPATION  is  defined  as  ''infrequent  or  incomplete  alvine  evacua- 
tion, leading  to  retention  of  feces." — (Quain.) 

With  this,  one  of  the  most  annoying,  as  well  as  one  of  the  most 
frequent  ills  to  which  mankind  is  heir,  Osteopathy  has  had  most  un- 
qualified success.  The  ordinary  sluggishness  of  the  bowels .  that  affects 
so  many  people  is  speedily  relieved,  ordinary  constipation  yields  almost 
as  readily,  while  some  very  marked  and  obstinate  cases  of  years  stand- 
ing have  been  cured.  I  have  known  of  a  lady  about  thirty-five  years  of 
age  constipated  from  birth,  having  never  had  a  natural  bowel  action,  to 
be  entirely  cured  in  six  months'  treatment.  I  have  been  told  by  one 
of  our  students  that  he  had  a  case  of  a  lady  older  than  that,  a  lady  eighty 


CONSTIPATION.  275 

years  of  age,  who  had  never  had  a  natural  action  of  the  bowels,  whose 
case  yielded  to  Osteopathic  treatment.  There  are  others  as  remarkable. 
Osteopathy  seldom  fails  to  cure  constipation  arising  from  the  usual 
causes.  Paralysis  of  the  bowels,  as  seen  in  some  cases  of  spinal  disease, 
and  in  general  paralysis,  can  be  handled  successfully  only  in  such  cases 
as  will  yield  in  regard  to  the  general  paralytic  symptoms.* 

In  the  matter  of  bowel  evacuation,  each  individual's  habit  is  a  law 
unto  himself.  Some  people  are  not  well  without  two  motions  daily, 
others  in  perfect  health,  go  as  long  as  three  days.  Raue  states  that  he 
has  known  women  in  perfect  health  to  have  but  one  evacuation  per  week. 
As  a  rule,  one  evacuation  per  diem  is  necessary  to  health.  But  it  must 
be  borne  in  mind  that  the  daily  evacuation  is  not  conclusive  evidence  of 
non-retention  of  fecal  matter.  The  quantity  of  the  motion  may  be  insuf- 
ficient. Cases  have  been  noted  in  .which  the  walls  and  sacculi  of  the 
colon  were  impacted  with  old  remnants,  while  a  regular  daily  stool, 
normal  in  consistence  and  color,  was  made,  passing  thus  through  a 
channel  whose  walls  were  formed  of  old  and  hardened  fecal  masses.  You 
will  find  in  the  retention  of  the  fecal  matter  that  there  is  an  irritation  of 
the  bowel  wall  and  a  catarrhal  condition  arising  from  this  irritation, 
hence  it  is  that  quite  often  there  is  an  alternate  constipated  and  diarrhoeal 
condition.  The  patient  will  have  constipation  for  awhile  and  diarrhoea 
for  a  while.  Dr.  Harry  Still  tells  us  that  he  has  found  in  his  experience 
that  if  the  liver  is  exceedingly  tender,  and  he 'asks  the  question,  "Are  you 
not  alternately  troubled  with  constipation  and  a  diarrhoeal  condition?" 

the  answer  is  usually  yes. 

• 
Symptoms: — The  head  is  dull  and  the  brain  lacks  vigor,  there  may  be 

headache,  dizziness,  palpitation  of  the  heart,  etc.  There  is  often  too  free 
secretion  of  saliva;  the  appetite  is  increased  or  lessened.  There  is  fre- 
quent biliousness,  pain  in  the  bowels  and  upon  defecation,  coldness  of 
the  extremities,  backache,  pains  in  the  lower  limbs,  etc.  The  memory 
is  poor,  the  head  confused,  the  complexion  sallow,  and  the  breath  bad 
On  the  other  hand,  people  with  rosy  complexions  and  every  appearance 
of  health  may  be  chronic  sufferers.  Constipation  is  a  symptom  in  a 
great  number  of  diseases. 

Aetiology: — General  and  Local: 

General: — The  causes  of  constipation  are  exceedingly  numerous,  and 
varied.  Too  concentrated  a  diet,  e.  g.,  milk,  by  leaving  too  little  residue 
to  act  as  an  irritant  to  the  bowel  wall,  stimulating  it  to  action,  becomes  a 
cause.  The  same  is  true  of  too  rich  foods.  Laziness,  late  hours  in  bed, 
and  neglect  of  the  regular  hour  are  all  causes.  I  have  a  patient  who  will 
be  constipated  every  time  she  oversleeps,  and  remains  long  in  bed,  simply 


*See  Appendix  20. 


276  CONSTIPATION. 

because  she  has  gone  past  the  regular  hour.  I  think  this  is  a  cause  with 
men  in  business  who  do  not  take  time  to  attend  to  the  regular  calls  of 
nature.  This  is  one  of  the  most  serious  causes  of  the  most  obstinate 
cases  of  constipation  you  will  meet. 

In  hereditary  cases,  the  factors  are  weak  bowel  muscles  and  nerve 
supply.  Robinson  instances  a  case  in  which  he  says  he  was  satisfied 
that  the  plexus  of  nerves,  the  inferior  mesenteric  ganglion  was  not  suffi- 
ciently developed,  and  he  went  to  work  by  proper  exercises,  horse-back 
riding,  etc.,  to  develop  the  ganglion.  The  child  had  inherited  weak 
'bowel  walls  and  a  weak  ganglion.  Weakened  muscles  result  from  anemia, 
etc.  Loss  of  the  fluids  of  the  body,  as  in  lactation,  profuse  sweating,  and 
after  diarrhoea,  in  diabetes  mellitus,  etc.,  may  frequently  be  causes.  You 
must  have  a  normal  amount  of  fluid  in  the  system.  I  have  found  cases 
in  which  a  certain  amount  of  water  had  to  be  prescribed  daily  in  order 
for  the  patient  to  drink  enough.  Often  the  physician  has  to  prescribe 
some  sort  of  table  water  to  get  enough  fluid  into  the  system.  Often  I 
prescribe  water  to  be  taken  in  the  morning  before  breakfast,  not  at 
breakfast  but  fifteen  minutes  or  a  half  hour  before.1 

The  use  of  foods  leaving  coarse,  dry  residue,  e.  g.,  corn  and  beans; 
the  use  of  strong  purgative  medicines,  etc.,  and  any  cause  lessening 
peristaltic  action  of  the  bowels  may  cause  constipation.  People  frequently 
take  a  teaspoonful  of  salt  in  the  morning,  washing  it  down  with  a  cup 
of  water.  It  will  do  all  right  for  awhile,  but  it  will  dry  the  bowel,  and 
the  powerful  action  of  the  salt  exhausts  the  blood  vessels  supplying  the 
bowel,  so  always  discourage  the  use. of  salt  by  a  patient. 

The  styptic  quality  of  the  tannin  contained  in  tea  acts  as  a  constipator 
by  lessening  their  secretions.  Lessening  or  change  in  the  quality  of  the 
bowel  secretions  and  the  secretions  of  the  liver  and  pancreas,  cause  con- 
stipation by  robbing  the  bowel  of  the  stimulus  gained  from  the  action  of 
these  fluids  upon  the  nerve  terminals. 

Too  great  muscular  activity,  nervousness,  excessive  mental  applica- 
tion, are  all  aetiological  factors. 

Among  the  local  causes  may  be  mentioned  mechanical  agents,  e.  g., 
a  displaced  coccyx,  a  tightened  sphincter  ani  muscle,  pressure  of  a  pelvic 
tumor,  or  of  a  gravid  or  misplaced  uterus,  impactions  of  the  colon, 
stricture  from  peritoneal  adhesion  or  hernia;  mechanical  stoppage  by  the 
presence  of  foreign  bodies  like  grape  seeds,  fruit  stones,  etc.  When  you 
have  peritoneal  adhesion  you  may  have  a  serious  case,  because  that  may 
progress  enough  to  stop  the  bowel  entirely. 

Osteopathic  Theory: — Mechanical  causes  aside,  the  Osteopathic  theory 
in  regard  to  constipation  is  that  some  lesion  to  the  spine  prevents  proper 
action  of  the  innervation  or  of  the  blood  flow  of  the  bowel,  leaving  it 
weak  and  ready  to  yield  to  any  of  the  above  mentioned  general  causes 


CONSTIPATION.  277 

of  constipation.  Auerbach's  plexus,  ruling  bowel  motion,  and  Meissner's 
plexus,  ruling  bowel  secretion,  are  intimately  connected  with  the  sympa- 
thetics  of  the  abdomen.  These  sympathetics  may  be  hindered  in  action 
by  some  spinal  obstruction  of  a  nature  and  in  a  manner  previously 
described.  Thus  either  secretion,  or  motion,  or  both,  may  be  affected 
and  constipation  result.  Or,  since  the  blood  flow  is  under  control  of  the 
sympathetics,  the  lesion  may  readily  affect  it  and  cause  the  trouble.  Hare 
(Practical  Therapeutics,  p.  489)  says.  "Experiments  have  shown  that  the 
circulation  of  the  blood  through  the  intestines  greatly  influences  peris- 
talsis, and  disorders  in  the  blood  supply  readily  bring  on  intestinal 
disorder."  He  also  says  that  "peristalsis  is  almost  entirely  a  reflex 
action,  depending  for  its  existence  upon  the  integrity  of  the  nervous 
plexuses  in  the  intestinal  walls,  namely  those  of  Auerbach  and  Meissner." 
Hence  effects  upon  these  plexuses  by  lesion  of  their  sympathetic  connec- 
tions might  be  of  such  a  nature  as  to  result  in  constipation. 

It  is  evident  that  lesion  to  the  spine  anywhere  in  the  splanchnic  area, 
fifth  to  the  twelfth  dorsa.1,  or  below,  might  be  the  cause  of  constipation, 
but  Osteopathic  practice  has  designated  certain  important  points  in  the 
spine  at  which  lesion  is  likely  to  be  followed  by  constipation.  Such  are 
the  second  lumbar,  fourth  and  fifth  lumbar,  and  fourth  sacral.  The  latter 
point  is  Significant  because  the  fourth  sacral  nerve  controls  the  sphincter 
ani  muscle,  and  lesion  of  it  may  so  affect  the  nerve  as  to  cause  undue 
contraction  of  the  sphincter,  and  thus  act  as  a  mechanical  cause  of  con- 
stipation. 

Lesions  of  the  splanchnics  or  solar  plexus,  affecting  the  liver  and 
the  pancreas  and  their  secretions,  also  become  causes  of  constipation. 

Byron  Robinson  has  lately  written  (Medical  Brief)  very  clearly  upon 
constipation  as  a  neurosis  of  the  fecal  reservoir,  as  he  calls  the  left  half 
of  the  transverse  colon,  the  descending  colon  and  the  sigmoid  flexure. 
He  makes  a  very  interesting  point,  that  the  small  intestine  and  large 
intestine,  (the  ascending  colon  and  the  right  half  of  the  transverse  part) 
are  subject  to  a  quicker  rythmic  action  from  their  innervation  than  is 
the  remaining  -part  of  the  bowel,  which  is  described  as  the  fecal  reservoir. 
This  portion  of  the  colon  is  under  control  of  the  inferior  mesenteric 
ganglion  situated  upon  the  inferior  mesenteric  artery,  and  sending  its 
branches  to  the  intestines.  Muscular  atrophy  of  the  bowel  walls  must  be 
referred  to  these  nerves,  since  they  control  the  lumen  of  the  blood  vessels. 
The  abdominal  train  may  be  abnormally  small  in  some  persons,  be 
under  developed1  and  thus  allow  of  insufficient  bowel  action. 

Neurasthenia,  also  deficient  blood  supply  to  the  parenchymal  ganglia 
of  Auerbach's  and  Meissner's  plexuses  are  frequent  causes  of  constipa- 
tion. In  these  cases  of  neurasthenia  which  you  will  meet,  you  will  usually 
fimi  constipation  as  a  factor,  and  you  will  become  able  to  recognize  and 


278  CONSTIPATION. 

ask  at  once  if  the  patient  has  constipation.    Simple  observation  is  a  great 
thing  to  put  you  on  the  right  track. 

The  movements  of  the  intestines  largely  depend,  he  says,  upon  the 
amount  of  fresh  blood  sent  to  these  ganglia.  Peristalsis,  so  far  from 
being  impaired  in  constipation,  may  be  increased,  but  be  in  vain. 

A  checked  blood  flow,  or  a  lack  of  blood,  as  in  anemia,  becomes  a 
cause. 

An  empty  bowel  is  a  still  one.  a  full  bowel  an  active  one. 

The  irritation  which  increases  peristalsis  may  also  narrow  the  lumen 
of  the  blood  vessels,  lessen  secretions  and  cause  constipation. 

In  enteroptosis  the  weakened  ligamentous  portions  of  the  omenta 
elongate  and  allow  the  organs,  including  the  intestines  and  stomach,  to 
sink  downward  from  their  natural  positions.  This"  weakness  of  the  liga- 
ments 'begins  from  loss  of  tone  in  the  abdominal  sympathetics,  and  you 
must  as  Osteopaths,  as  a  rule,  refer  that  to  lesions  along  the  spine.  I 
think  I  have  thoroughly  explained  that  point  before.  By  the  gravitation 
of  the  organs  downward,  the  nerve  plexuses  and  fibres  are  stretched  and 
still  further  weakened.  The  enteroptosis  allows  of  kinking  of  the  colon, 
especially  at  the  splenic  and  hepatic  flexures,  and  becomes  thus  a  mechan- 
ical cause  of  constipation.  It  also  interferes  with  the  blood  and  nerve 
supply  to  the  intestines,  hinders  muscular  action,  lessens  secretion  and 
absorption  and  thus  becomes  a  prolific  source  .of  constipation  and  of 
other  ills. 

Osteopathy  also  looks  upon  constipation  as  a  "neurosis  of  the  fecal 
reservoir."  It  recognizes  the  importance  of  free  blood  supply  to  the 
muscles  of  the  intestines  that  they  may  not  atrophy,  also  of  free  supply 
of  blood  to  the  parenchymal  ganglia  situated  within  the  walls  of  the 
intestines,  that  they  may  thus  be  stimulated  to  normal  action.  By  affect- 
ing the  sympathetic  connections,  'by  adjusting  all  abnormalities  that  may 
interfere  with  blood  and  nerve  flow.  Osteopathy  preserves  the  integrity 
of  bowel  action. 

It  looks  upon  the  weakness  of  the  sympathetics  that  allows  of  enter- 
optosis and  of  its  concomitant  ills,  as  due  to  some  spinal  lesion  which 
either  directly  or  indirectly  affects  and  weakens  sympathetic  life.  I  make 
that  broad  statement;  of  course  I  know  as  well  as  any  one  that  you  do 
not  always  find  spinal  lesions  in  constipation,  but  in  general  that  is  the 
explanation  we  give  and  in  general  that  is  correct.  You  may  have  torpid 
liver  which  may  in  itself  be  a  cause  for  constipation. 

Excepting  cases  of  constipation  caused  by  mechanical  agents,  the 
system  would  not  be  subject  to  the  operation  of  the  general  causes 
assigned  for  constipation,  were  spinal  life  perfectly  adjusted  and  main- 
tained. 


TREATMENT   OF    CONSTIPATION.  279 

Treatment: — It  is  divided  into  (a)  upon  the  spine;  (b)  upon  the  ab- 
domen; (c)  upon  the  neck;  (d)  upon  the  coccyx  and  local,  and  (e) 
adjuvants. 

(a)  The  purpose  of  the  former  is  to  remove  any  lesion  that  may  be 
interfering  with  sympathetic  life  or  cerebro-spinal  nerve  life  of  the  bowel. 
You  may  have,  of  course,  as  you  understand,  some  irritation  along  the 
spine   which   interferes   with   nerve   life,    so   when   I    examine   in   case   of 
constipation  I  always  look  for  a  lesion.     You  may  find  affected  in  consti- 
pation  the  splanchnic  area  and  the   region   below   as   far   down   as  the 
sacral.     All  of  these  lesions  I  described  in  treating  the  spine.     It  rrjay  be 
a  contracted  muscle,   a  slip   of  a   vertebra,   something  which   alters  the 
curves  of  the  spine,  or  any  one  of  these  lesions  described.     It  may  occur 
along  the  spine,  so  make  examination  in  the  areas  mentioned.     I  come 
to  the  second  lumbar,  and  I  often  do  not  find  it  out  of  place.    I  believe  I 
have  already  shown  you  the  treatment  for  the  second  lumbar.     Make  the 
second  lumbar  a  fixed  point,   counting  up  from  the  sacrum  below,   by 
placing  the  thumb  and  doubled  finger  against  it,  and  push  up  against  the 
thigh;   then  take  the  other  hand  at  the   same  place  and  make   a  fixed 
point  at  the  second  'umbar  while  you  raise  the  upper  part  of  the  body 
and  rotate  it  around  this  fixed  point,  thus  effectually  loosening  any  con- 
tracture  of  the  ligaments. 

The  third  and  fourth  lumbar  are  particularly  significant  to  us,  and  the 
fifth  lumbar  as  well,  since  lesions  there  may  affect  the  hypogastric  plexus, 
and  we  work  there  especially  to  affect  the  lower  hypogastric  and  pelvic 
plexuses.  Do  not  forget  to  attend  to  the  splanchnic  area  and  all  of  the 
sympathetic  connections  here  with  all  of  the  nerve  mechanism  of  the 
bowel.  You  know  between  the  eighth  and  ninth  dorsal  is  the  center  given 
for  the  liver,  so  always  work  along  that  region  in  constipation.  I  never 
stop  my  treatment  for  constipation  without  raising  the  eighth  to  twelfth 
ribs  on  the  right  side,  and  usually  it  is  after  I  have  treated  the  liver;  with 
the  patient  on  his  back,  I  reach  across,  grasping  the  right  arm  of  the 
patient  with  my  right  hand,  and  then  raise  it,  and  work  it  up  and  back 
to  raise  the  ribs. 

Why  do  we  work  upon  the  liver?  Because  we  wish  to  keep  the  flow 
of  bile  free.  It  seems  that  the  bile  is  one  of  the  best  lubricants  for  the  in- 
testines, and  has  a  great  deal  to  do  with  the  normal  stimulation.  At  the 
fourth  sacral,  desensitize  if  you  have  any  reason  for  supposing  the  sphinc- 
ter ani  is  affected.  You  determine  this  by  a  digital  examination.  Note 
the  first  to  fourth  lumbar  for  the  large  intestines.  Peristalsis  particularly 
at  the  ninth,  tenth  and  eleventh  dorsal,  either  by  raising  the  lower  ribs  or 
by  springing  the  spine  and  strengthening  that  region  in  the  ordinary  way. 

(b)  The  treatment  over  the  ABDOMEN.     I  work  at  the  solar  plexus 
in  constipation.     It  is  closely  associated  with  the  bowel  at  a  point  about 


280  TREATMENT  OF   CONSTIPATION. 

midway  between  the  umbilicus  and  the  ensiform  appendix;  by  deep  pres- 
sure in  this  region  yon  can  usually,  by  going  slowly,  bring  considerable 
pressure  upon  that  point.  In  people  with  bowel  trouble,  and  in  dyspeptics, 
you  will,  usually  find  it  quite  tender.  Do  not  be  rough,  but  you  can  push 
in  deeply  and  stimulate  these  centers.  Thus  you  reach  important  connec- 
tions not  only  with  the  intestines  but  also  with  the  liver.  Also  reach 
the  hypogastric  and  pelvic  plexuses  by  working  along  the  third,  fourth 
and  fifth  lumbar,  and  by  working  through  the  abdomen  in  front. 

Also,  there  is  mechanical  work  that  we  can  do  along  the  line  of  the 
colon.  Usually  it  is  best  to  begin  at  the  left  in  the  region  of  the  sigmoid 
flexure  and  work  up  to  the  ribs,  then  across  above  the  umbilicus  to  the 
corresponding  region  on  the  right,  and  on  down  to  the  right  iliac  fossa. 
You  work  along  the  line  of  the  (Tolon  and  get  such  mechanical  effect.  But 
as  I  said  before,  that  is  not  the  only  effect  we  get,  we  stimulate  the  bowel 
walls,  stimulating  Auerbach's  and  Meissner's  plexuses  in  the  bowel  wall, 
thus  reaching  the  nerve  supply. 

Further,  it  is  important  to  straighten  the  bowel  and  keep  it  free.  We 
reach  in  deeply  at  the  iliac  fossa  and  straighten  out  the  sigmoid ;  work  up 
against  the  course  of  the  bowel  and  tend  to  straighten  it.  You  can  some- 
times obtain  good  results  in  swelling  of  the  lower  limbs  by  reaching  in  here 
deeply  and  raising  the  intestines,  thus  relieving  the  femoral  blood  vessels. 
Now,  I  always  work  upon  the  liver,  that  of  course  is  one  of  the  important 
points  in  constipation.  .Have  the  patient  with  the  knees  flexed  and  lying 
evenly  disposed  upon  the  table.  Taking  the  left  hand,  I  insert  my  fingers 
under  the  edge  of  the  right  ribs  against  the  edge  of  the  liver.  You  must 
be  careful  not  to  bruise  the  liver.  You  can  also  get  a  squeezing  motion 
upon  the  liver  by  reaching  in  below  the  right  side  and  working  on  top  of  the 
ribs  in  front,  and  pressing  the  liver.  Then  we  work  along  the  course  of 
the  bile  duct.  This  is  upon  the  right  as  you  know,  curved  in  the  shape  of 
a  reversed  S,  so  we  work  back  along  the  S  with  the  idea  of  freeing  it. 
Sometimes  in  catarrhal  conditions  you  will  have  a  mucous  plug  formed 
and  the  duct  stopped. 

Also  I  stimulate  the  inferior  mesenteric  ganglion  by  working  the  bowel 
a  little  below  and  to  the  left  of  the  umbilicus.  This  is  important,  since  as 
we  see,  this  ganglion  controls  the  part  of  the  colon  described  as  the  fecal 
reservoir. 

(c)  The  treatment  in  the  NECK.  Hare  says,  "The  vagus  nerves  when 
stimulated  directly  or  reflexly  increase  peristalsis."  Always  in  constipation 
we  stimulate  the  pneumogastric,  thereby  increasing  the  peristalsis,  in  two 
ways,  one  by  working  along  the  sterno-mastoid  muscle,  and  the  other 
working  upon  the  superior  cervical  ganglion,  which  we  reach  at  the  sub- 
occipital  fossa. 


TREATMENT   OF   CONSTIPATION.  281 

(d)  LOCAL: — Adjust   the   coccyx   if  displaced.      Sometimes   external 
manipulation  is  sufficient;   sometimes,  and  usually,   internal  manipulation 
must  be  employed  in  the  manner  already  described,   but  always  in  case 
of  constipation  see  that  the  coccyx  is  perfectly  disposed  that  it  may  not 
act  as  a  mechanical  impediment  to  the  passage  of  fecal  matter.    A  further 
local  treatment  is  dilation  of  the  rectum,  relaxing  the  sphincter  muscle. 
This  treatment  is  applied  simply  by  insertion  of  the  index  finger  and  by 
a  spreading  motion.     It  should  not  be  given  often er  than  once  a  week, 
or  once  in  ten  days  or  two  weeks.    This  rectal  dilation  is  a  great  stimula- 
tion to  the  sympathetic  system  and  not  only  for  normal  bowel  action, 
but  it  is  frequently  resorted  to  to  stimulate  the  lungs.    In  case  of  a  patient 
sinking   under    anesthesia,    one    of   the    quickest    and    simplest    ways    to 
restore  the  patient  is  by  rectal  dilatation. 

(e)  Adjuvants: — Remember  that  I  simply  give  these  to  you  as  aids 
to  your  Osteopathic  work,  they  are  not  Osteopathy.     If  they  were  more 
frequently    employed,    fewer    would   suffer    from    this    complaint.       The 
use  of  water  is  of  great  benefit.     The  drinking  of  cold  or  warm  water 
fifteen    or  twenty   minutes    or   half   an    hour   before   breakfast    is    often 
sufficient  to  cause  a  full  evacuation.     It  should  not  t>e  taken  with  the 
breakfast  as  it  does  no  good  then.       The  theory  is  explained  that  when 
the  stomach  is  empty  a  portion  of  the  water,  at  least,  is  not  absorbed 
directly  from   the   stomach   as   water   ordinarily   is,   but   passes   on   into 
the  small  intestines   and  is  there  absorbed  by  the  lacteals  and  carried 
into   the   portal    circulation    and   stimulates   the   flow   of  bile.      Often    a 
good    drink    of   water    upon    retiring    will    accomplish    the    same     pur- 
pose.      We  frequently  use  anemas  of  hot   or   cold  water.       It   is  said 
that  a  small  anema  of  cold  water  is  a  great  stimulation,  though  anemas 
are  usually  given  of  water  as  hot  as  can  be  well  borne.     It  should  be 
given  by  a  fountain    syringe,    the    patient    lying    upon    the    back    or 
upon  the  right  side,  having  the  syringe  hung  at  a  hight  of  six  feet  to  in- 
sure a  sufficient  fall.     About  a  pint  should  be  given  and  the  patient  should 
immediately  void   this.     The  operation  is  repeated,   this  time  giving  one 
quart,  three  pints  or  even  more  of  water.    Stimulate  gently  by  working  the 
abdomen,  in  order  that  the  water  may  be  taken  up  into  the  bowel.     The 
patient  should  now  retain  this  as  long  as  possible  in  order  that  the  fecal 
matter  may  be  well  softened.     Many  make  a  mistake  in  voiding  the  water 
before  it  has  been  held  sufficient  time  to  act  as  a  solvent  of  the  fecal 
masses  which  may  have  been  quite  hard.     When  he  has  held  it  as  long  as 
possible,  usually  that  will  not  be  but  a  few  minutes,  he  should  void  it,  and 
ordinarily  the  result  will  be  satisfactory.     Sometimes  your  patient  will  not 
be  able  to  pass  the  water,  but  if  retained  it  does  nothing  but  good,  as  it  is 
acting  continually  as  a  solvent  and  will  probably  within  a  few  hours  lead  to 


282  TREATMENT   OF    CONSTIPATION. 

a  profuse  action,  but  if  it  does  not  it  is  readily  absorbed  and  carried  out 
through  the  kidneys  and  bladder. 

Drinking  of  carbonated  and  sulphur  waters  usually  develops  some 
good  conditions.  JLJsually  in  sulphur  water  there  is  magnesium  which 
has  -an  aperient  action.  Graham  bread  contains  salts  which  stimulate 
the  normal  action  of  the  bowels,  also  the  roughness  of  the  reminants  of 
the  bran  is  of  itself  a  good  stimulation  of  the  bowel  walls.  Cracked 
wheat,  oatmeal,  vegetables,  whole  wheat  bread,  etc.,  are  all  alike  valuable 
foods.  Now,  remember  that  one  may  take  too  great  quantities  of  these 
foods  and  become  constipated. 

Again  fruits  are  a  great  help.  I  will  mention  first  such  as  are  consti- 
pating and  should  be  avoided,  such  as  strawberries,  blackberries  and 
raspberries.  Raspberry  juice  is  frequently  given  in  case  of  diarrhoea, 
where  you  readily  note  its  constipating  effect.  But  such  fruits  as  apples, 
grapes  (no  seeds),  stewed  prunes,  figs,  dates,  and  juicy  fruits,  especially 
before  breakfast,  or  the  first  thing  at  breakfast,  are  laxative.  These  are 
all  valuable,  apples  perhaps  the  most  so,  though  different  people  are 
affected  differently.  It  would  seem,  however,  that  apples,  prunes  and 
dates  are  to  be  given  the  preference. 

Regular  habits  should  be  encouraged.  Defecation  is  found  to  be 
largely  a  matter  of  habit,  acquired  generations  back  and  passed  on  from 
generation  to  generation.  A  certain  hour  should  be  fixed  for  the  stool, 
and  the  patient  at  least  go  and  try  to  produce  evacuation,  never,  how- 
ever, straining  as  that  may  produce  hemorrhoids,  but  by  thus  fixing  the 
habit  and  placing  the  mind  on  the  desired  end,  you  control  the  cerebral 
centers. 

Aside  from  the  regular  habit  of  going  to  stool,  certain  exercises  are 
beneficial;  remember  first,  however,  that  violent  muscular  exercise  is 
given  as  one  of  the  causes  of  constipation,  and  have  your  patient  care- 
fully avoid  fatigue  in  exercise.  The  following  exercises  are  recom- 
mended: 

First  the  stooping  motion,  the  patient  bending  .the  knees,  keeping 
the  back  straight,  stooping  down  and  raising,  brings  a  pressing  or 
squeezing  motion  upon  the  liver.  He  may,  in  bending  downward,  bend 
forward  until  the  shoulders  touch  the  knees..  The  same  effect  is  accom- 
plished by  the  patient  getting  down  on  all  fours  and  running  about  the 
room.  This  seems  to  be  a  natural  way  of  massaging  the  liver.  The 
patient  may,  when  he  awakens  in  the  morning,  while  lying  upon  the 
back,  tap  and  massage  the  abdomen  gently  and  thoroughly  and  thus 
stimulate  the  blood  and  nerve  force  of  the  bowel  and  gain  the  desired  end. 

Horseback  riding  and  ordinary  enjoyable  exercises  are  all  very 
good. 


DIARRHOEA  AND  DYSENTERY.  283 

LECTURE  X. 

DIARRHOEA   AND   DYSENTERY. 

The  success  of  Osteopathic  treatment  in  both  Diarrhoea  and  Dysen- 
tery is  marked.  As  a  rule,  the  copious  evacuation  of  acute  Diarrhoea 
is  checked  immediately  upon  'the  first  treatment,  though  frequently  cases 
need  more  than  one  treatment,  and  sometimes  become  obstinate  and 
chronic,  requiring  months. 

Dysentery,  although  a  more  serious  condition,  being  essentially  an 
inflammation  of  the  bowels,  yields  readily  to  our  treatment.  The  treat- 
ment is  similar  in  both  cases. 

Both  of  these  conditions  will  illustrate,  in  their  treatment,  two 
points  in  Osteopathic  theory:  First,  the  condition  of  the  spine  as  a  pre- 
disposition to  disease;  second,  the  remarkable  control  gained  over  vis- 
ceral life  by  manipulation  of  the  controlling  nerves. 

DIARRHOEA  is  regarded  by  some  writers  as  a  symptom  merely  of  intes- 
tinal derangement,  by  others  as  a  distinct  disease:  The  word  means  "to 
run  through,"  and  as  Hare  observes  is  loosely  applied  to  all  states  of  in- 
testinal disturbance  accompanied  by  liquid  stools. 

Aetiology: — Hare  notes  four  varieties  of  Diarrhoea:  i.  Catarrh  of 
the  intestines,  leading  to  profuse  secretion  and  passage  of  mucous.  Irri- 
tation set  up  by  old  fecal  matter  may  be  enough  to  set  up  inflammation 
resulting  in  a  discharge  so  that  you  may  have  alteration  of  diarrhoea  and 
constipation.  2.  Lack  of  proper  innervation  of  the  blood  vessels  allows 
of  an  outpouring  of  liquid  from  them  into  the  intestines.  Right  here 
you  must  guard  against  an  error  frequently  made  by  some  who  treat  Diar- 
rhoea as  if  it  were  caused  solely  by  too  rapid  peristalsis.  They  make  the 
same  mistake  as  is  made  in  considering  constipation  always  to  be  a  lack 
of  peristalsis.  It  should  be  considered  simply  as  one  of  the  classes. 
3.  Improper  condition  of  the  glands  leads  to  improper  preparation  of  the 
digestive  fluids,  and,  4.  Ulceration,  causing  irritation  and  bloody  purg- 
ing. 

Byron  Robinson  notes  the  fact  that  Diarrhoea  may  start  as  conges- 
tion, leading  to  oedema,  rapid  exudation,  and  Diarrhoea.  Thus,  catching 
cold  frequently  affects  the  bowels  in  this  way,  particularly  in  young 
children.  He  further  points  out  that  increased  peristalsis  may  be  accom- 
panied by  too  profuse  secretion  and  exudation,  but  that  on  the  other 
hand,  increased  peristalsis  'may  be  accompanied  by  narrowing  of  tht 
calibre  of  the  blood  vessels  and  lessened  secretion.  Thus  the  irritation 
that  causes  the  increased  vermicular  motion  may  cause  constipation 
instead  of  diarrhoea.  Such  causes  as  influence  intestinal  peristalsis  are 
important  to  the  Osteopath,  as  he  finds  in  spinal  abnormalities  the  fre- 
quent cause  of  nervous  irritation  leading  to  diarrhoea  or  to  constipation. 


284  DIARRHOEA   AND   DYSENTERY. 

The  processes  of  secretion  and  absorption  normally  balancing  each 
other,  may,  says  Robinsson,  become  disarranged  through  the  irritation 
of  the  bowel  segments,  e.  g.,  by  cathartic  medicines.  Owing  to  the  in- 
creased peristalsis,  not  enough  time  is  allowed  for  absorption  of  the 
secretions,  and  they  are  hurried  through  the  bowel  in  the  form  of  liquid 
stools. 

Displacement  of  spinal  parts,  etc.,  may  be  the  cause  of  such  irrita- 
tion, as  our  practice  frequently  shows. 

The  same  author  shows  that  catarrh  of  the  intestinal  mucous  mem- 
brane may  so  affect  intestinal  secretions  in  quantity  and  character  as  to 
alternately  cause  Diarrhoea  and  Constipation. 

Dr.  Harry  Still  says  that  in  cases  where  he  finds  the  liver  extremely 
tender,  he  usually  finds  diarrhoea  and  constipation  alternating. 

Causes  of  Diarrhoea  are  predisposing  and  exciting. 

Predisposing  causes  are  heredity,  personal  idiosyncracy,  tinle  of  life, 
e.  g.,  teething  and  the  climacteric;  and,  from  the  Osteopathic  point  of 
view,  spinal  conditions,  any  obstruction  or  irritation  of  blood  or  nerve 
life  of  the  intestines. 

Exciting  causes  are: — (Quain.) 

1.  Direct  irritation,  as  by  poorly  digested  food  upon  the  intestinal 
walls;  entozoa;  excessive  bile,  or  retained  fecal  matter. 

2.  Bad  hygiene,  as  living  in  damp,  badly  lighted  and  poorly  ventil- 
ated quarters. 

3.  Exposure,  wet  feet,  sudden  atmospheric  change,  etc. 

4.  Nervous  causes,  e.  g.,  depression,  worry,  shock,  grief,  reflex  irri- 
tation in  dentition. 

5.  Altered  peristalsis  and  secretions. 

6.  General  diseases;  e.  g.,  of  the  heart,  liver,  lungs,  pyaemia,  perit- 
onitis, obstruction  of  the  portal  vein,  measles,  scarlatina,  typhoid,  etc. 
(Symptomatic  Diarrhoea.) 

Osteopathic  Theory: — While  admitting  the  potency  of  varied  agencies 
to  cause  Diarrhoea,  the  Osteopath  'believes  that  most  cases  can  be 
accounted  for,  either  remotely  or  directly,  by  some  abnormal  condition 
of  some  part  of  the  spine,  particularly  of  the  splanchnic  area  and  of  the 
lower  region  of  the  spine.  A  spinal  lesion  of  any  nature,  may  be  of  such 
a  character  as  to  influence  the  nervous  mechanism  controlling  the  whole 
of  the  intestinal  life,  and  the  result  may  be  violent  and  rapid  peristalsis, 
vaso-dilatation  of  the  mesenteric  vessels,  followed  by  increased  exuda- 
tions, abnormal  glandular  activity,  producing  perverted  or  needless  secre- 
tions of  intestinal  juices,  or  inflammation  and  catarrhal  affection  of  the 
mucous  membranes,  as  pointed  out  above. 

As  a  predisposing  cause,  bad  spinal  condition  stands  pre-eminent. 
If  the  exciting  cause  be  error  in  diet,  exposure,  undue  nervous  excite- 


DIARRHOEA   AND   DYSENTERY.  285 

ment,  unhygienic  surroundings,  or  a  general  disease,  it  may  still  be  true 
that  the  bad  spinal  condition  allows  of  a  weakness  of  such  a  nature  as  to 
be  readily  developed  into  Diarrhoea  by  any  one  of  those  causes  acting  in 
conjunction  therewith. 

Granted  that  in  certain  cases,  c.  g.,  when  Diarrhoea  is  purely  symp- 
tomatic, no  such  remote  causes  can  be  found  in  the  spine  primarily,  yet 
because  treatment  at  the  proper  spinal  position  will  overcome  the  symp- 
tom, the  theory  still  hclds  gocd  so  far  as  to  direct  the  operator  to  the 
origin  of  nerves  governing  the  part  affected,  while  contractured  muscles, 
caused  secondarily  by  irritation  sent  outward  from  the  bowel  through 
nerve  connections  to  them,  frequently  indicate  to  us  the  proper  point  of 
treatment  upon  the  spine. 

DYSENTERY  (Bloody  Flux): — This  is  a  febrile  disease  characterized 
by  intestinal  inflammation,  the  passage  of  blood,  mucous,  etc.,  and  great 
prostration.  It  occurs  epidemically  or  sporadically,  and  attacks  males  and 
females  of  all  ages. 

Aetiology: — The  causes  of  Dysentery  seem  to  operate  most  freely  in 
tropical  climates,  in  damp  or  swampy  localities.  It  is  said  to  generally 
occur  in  regions  which  are  prone  to  malarial  infection,  and  that  malaria 
seems  to  predispose  to  it  by  abdominal  congestion,  engorgement  of  the  liver 
and  spleen,  and  digestive  derangement.  Hence  it  is  to  some  extent  a  con- 
stitutional disease.  It  is  seen  in  greatest  virulence  in  army  camps  and  hos- 
pitals, where  it  best  manifests  its  epidemic  character. 

Sporadic  cases  are  usually  caused  by  some  indiscretion  in  diet,  by 
sudden  chilling  of  the  body,  wet  feet,  etc.  Impure  drinking  water,  bad 
air,  undigested  particles  of  food,  and  sudden  changes  in  temperature  which 
cause  internal  congestions,  are  all  assigned  as  causes. 

It  is  stated  that  Virchow  considers  the  epidemic  form  to  be  of  a 
diphtheritic  nature  and  the  sporadic  form  of  a  catarrhal  nature. 

The  epidemic  form  is  held  by  some  to  be  contagious,  but  this  is  a 
mooted  question. 

Pathology: — This  is  a  disease  of  the  large  intestine,  but  may  extend 
beyond  the  ilio-csecal  valve  into  the  small  intestine.  The  first  change  is  a 
reddening  and  swelling  of  the  mucous  membrane  which  peels  off  and  is 
passed  in  the  stools. 

Ulceration  may  attack  and  destroy  the  solitary  glands,  spreading  thence 
to  the  tubular  glands.  From  these  ulcerations  perforation  of  the  bowel 
may  occur.  The  Ilio-csecal  valve  is  sometimes  destroyed  when  the  dysen- 
tery is  gangreous,  and  invagination  follows.  Ordinarily  the  whole  surface 
of  the  mucous  membrane  becomes  colored  with  a  dirty,  varicolored  slime, 
mixed  with  epithelial,  blood,  and  pus  cells,  and  causing  very  offensive 
stools.  Sometimes  the  mucous  membrane  decays,  is  sloughed  off  and 
passed. 


286  DIARRHOEA   AND   DYSENTERY. 

Inflammation  extends  to  the  peritoneum  and  involves  the  mesenteric 
glands.  It  is  said  that  the  ulcerated  tissue  is  probably  never  restored,  and 
that  occasionally  serious  contractions  of  the  gut,  or  stricture,  may  follow 
the  healing  of  the  ulcers. 

Symptoms: — There  are  at  first  general  constitutional  and  digestive 
disturbances.  Chilliness,  malaise,  fever  in  the  evening,  dry  skin,  constipa- 
tion or  relaxation  of  the  bowels,  anxious  expression,  occasionally  retention 
of  urine,  and  offensive  stools  are  among  the  symptoms. 

The  tongue  is  furred;  there  is  a  thirst  and  bad  taste;  evacuation  is 
accompanied  with  great  pain  followed  by  tenesmus,  a  bearing  down  feeling 
of  the  rectum;  tormina  or  griping,  is  usually  present. 

The  stool  is  characteristic;  described  by  Raue  as  being  first  liquid, 
with  transparent,  jelly-like  clots  of  slime,  like  boiled  sago.  This  matter 
is  tinged  with  blood,  contains  little  or  no  fecal  matter,  and  later  becomes 
thin,  dirty  white  and  watery.  The  stool  may  become  clear  blood.  The 
decaying  membranes  and  ulcers  give  it  a  particularly  offensive  odor. 
Twenty,  thirty  or  more  stools  are  had  in  twenty-four  hours. 

The  attack  is  likely  to  prove  fatal,  and  we  must  guard  against  such 
unfavorable  symptoms  as  hemorrhage,  cold  skin,  great  prostration,  livid 
and  blue  countenance,-  collapsed  abdominal  walls,  peritonitis,  pneumonia, 
erysipelas,  bed  sore  and  hepatic  ulcer. 

Osteopathic  Theory: — Some  spinal  lesion,  especially  at  the  splanchnic 
area  or  at  the  third  and  fourth  lumbar,  disarranges  blood  and  nerve  supply 
to  the  intestines,  thus  acting  as  a  predisposing  cause,  rendering  the  system 
more  susceptible  to  the  influence  of  poor  diet,  climatic  change  or  con- 
tagion. 

Treatment: — Look  for  lesion  along  the  splanchnics,  and  see  that  the 
coccyx  is  straight.  There  seems  to  be  a  special  significance  attached  to  the 
nth  and  I2th  dorsal.  These  seem  to  be  centers  particularly  for  peristalsis, 
or  lesions  of  the  nth  and  I2th  ribs  may  influence  these  centers.  The 
treatment  for  Diarrhoea  is  very  simple.  I  place  the  patient  upon  the  side 
and  work  along  the  lumbar  region,  springing  the  spine  strongly.  I  do  not 
hesitate  to  make  it  strong.  Place  the  knees  of  the  patient  against  you  and 
give  a  very  strong  treatment.  If  the  patient  is  a  small  man  sometimes  you 
can  raise  him  off  the  table,  and  that  will  not  be  too  strong  a  treatment. 
Of  course  you  will  have  to  gauge  your  treatment  according  to  the  condition 
of  the  patient.  I  work  that  way  all  along  from  the  lower  lumbar  as  high 
as  to  the  sixth  dorsal.  I  hold  for  a  minute  or  two,  then  I  turn  the  patient 
over  onto  the  other  side  and  repeat  the  operation.  Some  operators  think 
that  by  treating  just  on  the  right  side  they  get  good  results.  I  think  it  is 
simply  a  matter  of  desensitizing  the  spine— inhibiting  the  nerves.  Of  course 
that  sounds  like  the  theory  entirely  of  peristalsis,  but  you  rule  the  vaso- 


DIARRHOEA   AND   DYSENTERY.  287 

motor  action  there,  and  you  get  effect  upon  the  liver,   spleen  and  solar 
plexus. 

With  the  patient  upon  the  back  I  raise  the  nth  and  I2th  ribs,  or  with 
the  patient  upon  his  side  I  work  in  at  the  point  of  the  nth  and  I2th  ribs. 
Putting  the  thumb  against  the  angle  you  can  hold  there  strongly,  with  the 
idea  of  inhibiting  nerve  action. 

I  never  hesitate  to  have  a  good  flow  of  bile  to  the  intestines  in  case  of 
Diarrhoea.  The  theory  is  that  we  work  on  the  bile  to  stimulate  its  flow  to 
the  bowel,  and  you  will  find  that  it  will  act  to  allay  irritation.  I  work  on 
the  course  of  the  bile  duct  to  insure  a  freedom  of  the  flow  of  bile  to  the 
intestines.  It  will  never  do  any  harm  in  the  case  of  diarrhoea  or  dysentery, 
as  well  as  in  case  of  constipation.  This  then  is  the  general  treatment  in 
cases  of  diarrhoea,  dysentery,  and  similar  troubles.  Now,  if  it  is  a  severe 
case  of  dysentery,  when  you  work  upon  the  abdomen  you  must  be  careful 
not  to  run  any  risk  of  perforation,  which  is  likely  to  occur.  I  work  over, 
the  bowel  as  in  typhoid  fever,  simply  to  relax  the  tissues  and  free  the  flow 
of  fluids,  reaching  the  hypogastric  plexus.  In  chronic  cases,  where  there 
is  inflammation  of  the  bowel,  you  will  find  the  bowel  contracted,  and  then 
by  working  gently  but  deeply  over  the  site  of  the  contracture  you  can 
relax.  I  am  treating  a  case  now  of  long  standing.  There  is  a  contraction 
of  the  bowel  on  one  side  or  on  the  other.  .  It  may  be  on  the  right,  or 
may  be  on  the  left,  varying  from  time  to  time.  I  work  on  the  centers 
along  the  spine.  I  spent  considerable  time  one  morning  in  giving  the 
treatment,  in  trying  to  relax  this  condition.  I  worked  from  the  middle 
dorsal  down,  but  none  of  it  seemed  to  do  as  much  good  as  to  get  directly 
to  the  seat  of  the  contracture  by  working  in  the  abdomen.  You  may  say 
that  tends  more  to  massage  than  to  Osteopathy.  That  is  true  so  far  as 
that  case  is  concerned,  but  differs  in  having  the  origin  of  the  trouble  in 
the  spine. 

We  work  first  upon  the  spine,  second  upon  the  abdomen;  we  also  work 
upon  the  neck  to  inhibit  the  pneumogastric.  Stimulation  of  the  pneumo- 
gastric  will  increase  the  peristalsis,  according  to  Hare.  You  bring  pressure 
upon  these  nerves  by  working  along  the  mastoid  muscle.  You  must  make 
local  examination  and  satisfy  yourself  that  the  coccyx  is  straight.  Some- 
times it  is  displaced  and  is  the  cause  of  the  trouble. 

In  case  of  rectal  troubles  you  must,  of  course,  treat  the  sacral  nerves, 
as  they  have  to  do  with  the  rectum. 

Also  there  are  certain  ADJUVANTS  which  we  may  use.  Quiet  and  rest 
in  bed  in  severe  cases,  with  proper  care  as  to  diet ;  meat  broths,  tepid  (not 
hot)  water,  as  hot  water  or  hot  liquid  food  will  excite  peristalsis.  Use 
milk  with  lime  water,  also  mucilaginous  drinks  such  as  white  of  egg  in 
water,  milk,  rice  or  barley  water.  Avoid  fruits,  except  such  as  are  con- 


288  MASSAGE,   SWEDISH   MOVEMENT   AND   MANUAL  TREATMENT. 

stipating,  e.    g.,    blackberries    and    strawberries.     Tea    is    an    astringent. 
Strong  tea  and  toast  may  be  given. 

It  is  simply  common  sense  adjuvant  methods  that  are  used.  One 
should  not  include  these  in  Osteopathic  treatment  unless  necessary.  Or- 
dinary cases  of  diarrhoea  you  will  be  able  to  stop  with  the  treatment  alone. 

As  to  Dysentery,  the  same  general  treatment  given  above  will  apply. 
You  must,  however,  give  a  more  general  spinal  treatment,  especially  for  the 
liver,  spleen,  stomach  and  intestine.  Dr.  McConnel  has  said  that  there  is 
invariably  a  lesion  at  the  3d  and  4th  lumbar  in  case  of  dysentery.  Get  the 
liver  active.  Frequently  you  can  relieve  portal  congestion  and  do  away 
with  danger  in  that  direction. 

In  tormina  I  sometimes  bring  deep  pressure  over  the  solar  plexus,  but 
usually  work  upon  the  splanchnics.  I  have  the  patient  upon  the  side,  or 
upon  a  chair,  and  spring  all  along.  This  is  the  ordinary  griping  in  the 
intestines. 

For  the  bearing  down  feeling  in  the  rectum,  strong  stimulation  in  the 
sacral  region  will  be  sufficient.  Sometimes  it  is  necessary  to  give  an 
anema,  and  then  tepid  water  should  be  used.  A  mustard  plaster  may  be 
good  to  relieve,  but  it  should  not  be  left  on  over  twenty  minutes,  not  long 
enough  to  blister.  I  have  before  mentioned  that  the  patient  should  not  be 
allowed  to  drink  a  quantity  of  liquid  at  once.  Just  a  few  spoonfuls  of 
water  should  be  given  at  a  time  to  relieve  thirst. 

Question.     In  treating  the  pneumogastric  do  you  inhibit  or  stimulate? 

Answer.  The  general  way  is  to  hold  -strongly  against  the  mastoid 
muscle.  We  do  not  depend  simply  upon  the  pneumogastric  in  these 
troubles.  I  have  not  found  that  I  could  do  so. 

Question.     How  often  do  you  give  treatments  for  diarrhoea? 

Answer.  I  treat  such  cases  several  times  a  day.  It  is  owing  to  the 
nature  of  the  case.  If  it  is  an  acute  case  you  must  keep  after  it.  Treat 
three  or  four  or  a  half  a  dozen  times  a  day. 

Question.  Would  it  do  to  give  cracked  ice  instead  of  water  to  quench 
thirst? 

Answer.     Yes,  that  would  do  in  small  quantities. 


LECTURE  XI. 

Massage,  Swedish  Movement  and  Manual  Treatment: — These  are  all 
forms  of  mechanical  therapeutics.  All  are,  at  least  in  part,  manual  sys- 
tems, the  treatment  being  administered  with  the  hands.  In  each  system 
not  only  manipulative  procedure  is  employed,  but  also  gymnastics  are 
used,  i.  e.,  passive,  resisted,  or  free  movements  on  the  part  of  the  patient. 


MASSAGE,  SWEDISH  MOVEMENT  AND  MANUAL  TREATMENT.  289 

Massage  seems  to  consist  largely  of  manipulations  made  by  the  operator 
on  the  patient's  body,  while  Swedish  movement,  though  including  these 
manipulations,  makes  prominent  the  active  gymnastics  of  the  patient  and 
is  called  also  Medical  Gymnastics. 

The  system  of  manual  treatment  ascribed  to  Ling,  a  Swede,  seems  to  be 
a  more  thorough  form  of  massage  in  which  the  manipulations  predominate, 
but  including  also  certain  active  movements  on  the  part  of  the  patient. 

In  general,  these  systems  are  but  little  understood,  and  are  far  more 
thorough  as  methods  of  healing  than  is  generally  supposed.  In  the  hands 
of  skillful  operators,  usually  doctors  of  medicine,  remarkable  results  have 
been  accomplished  in  the  cure  of  disease.  These  systems  are  generally 
employed  by  masseurs  without  technical  education,  and  thus  have  come  to 
be  generally  misunuer stood;  being  as  a  rule  unskillfully  applied,  and  by 
uiiscienuhc  operators,  the  results  have  not  been  such  as  the  systems  are 
enable  of  producing.  However,  none  of  these  forms  of  treatment  are 
Osteopathy;  all  dirter  from  it  radically,  yet  since  they  are  systems  of 
manipulative  therapeutics,  and  since,  unavoidably  in  any  such  general  mode 
of  treatment,  there  are  certain  resemblances  in  method,  in  manner,  or  in 
results,  Osteopathy  has  been  frequently  confounded  with  these  otUer 
methods. 

Massage  is  the  general  term  used  by  the  average  man  to  designate  all 
forms  of  manual  treatment,  hence  Osteopathy  has  become  to  him  massage. 

In  Eccles'  ".Practice  of  Massage"  rive  different  forms  of  manipulation 
are  described,  as  follows : 

1.  Effteurage,  or  stroking;  for  effects  upon  the  skin;  given  in  a  centri- 
petal direction  to  aid  the  flow  of  lymph  and  blood  toward  the  heart. 

2.  fetrissage,  or  kneading;  deeper  than  stroking;  for  effect  upon  skin 
and  muscle  in  direction  of  blood  flow  to  the  heart,  and  for  the  purpose  of 
squeezing  out  the  waste  from  the  tissues.      It  stimulates  lymph  and  blood 
How. 

3.  Tapotement,  or  tapping,  clapping  or  hacking.     This  is  given  with 
the  dorsal  surface  of  the-  second  and  third  phalanges,  or  with  the  ulnar  or 
radial  border  of  the  hand,  for  the  purpose  of  affecting  deeper  structures,  i. 
e.,  for  stimulation. 

4.  Vibration,  a  quick  vibratory  motion,  variously  administered,  given 
over   chest,   abdomen,    nerve  trunks,   etc.,   for   stimulation   of   the   deeper 
viscera  or  nerves. 

1  5.  Massage  a  friction,  a  sort  of  "circular  friction,  generally  employed 
about  joints  to  soften  tissues  and  muscles;  said  to  be  very  useful  in  sprains, 
strains  and  rheumatism. 

These  five  forms  of  motion,  sometimes  more,  are  described  by  the  dif- 
ferent authors.    There  is  much  variation  in  the  technique.    Usually  a  mas- 
.  seur,  after  a  course  of  study,  will  throw  aside  his  books  and  adopt  a  system 


290  MASSAGE,  SWEDISH  MOVEMENT  AND  MANUAL  TREATMENT. 

of  motions  of  his  own.  Yet,  unlike  in  Osteopathy,  the  manual  of  technique, 
or  the  exact  mode  of  administering  the  various  movements,  is  made  very 
important  by  the  authors.  One  example  will  illustrate  the  detail  with 
which  these  motions  are  described,  and  the  careful  attention  that  is  be- 
stowed upon  the  manner  of  giving  the  treatment : 

"The  rubber,  remaining  upon  the  left  side  of  the  couch,  uncovers  the 
left  lower  limb,  and  with  the  right  hand  delivers  a  series  of  rapid  frictions 
from  the  toes  upward  over  the  dorsum  of  the  foot,  external  surface  of  the 
leg,  the  knee,  and  front  and  external  surface  of  the  thigh;  then  with  the 
left  hand,  the  knee  being  semi-flexed  and  the  thigh  slightly  abducted  and 
rotated  outward,  the  sole  of  the  foot,  calf,  inner  side  of  the  knee  and 
thigh,  are  also  lightly  and  briskly  rubbed ;  then,  re-covering  the  limb,  and 
exposing  the  foot  and  ankle  only,  the  more  detailed  treatment  of  the  foot 
is  given.  Supporting  the  sole  of  the  foot  in  the  palm  of  the  left  hand,  the 
heel  resting  in  the  semi-flexed  fingers,  friction  over  the  dorsum  of  the 
foot  and  the  front  and  outer  surface  of  the  ankle  is  performed  in  much 
the  same  manner  as  that  of  the  back  of  the  hand." 

The  masseur  thus  goes  over  the  body  in  detail  in  general  treatments. 
There  is  special  massage  for  the  limbs,  the  heart,  the  lungs,  the  eyes,  the 
face,  the  ear,  the  head,  the  bladder,  intestines,  etc. 

The  time  required  for  treatment  varies  from  a  few  moments  to  three 
quarters  of  an  hour  or  an  hour  and  a  quarter. 

In  addition  to  the  movements  described,  massage  includes  voluntary 
motions  by  the  patient,  sometimes  aided,  sometimes  free,  sometimes  re- 
sisted by  the  operator.  These  come  after  the  passive  massaging,  and  are 
for  the  effects  of  exercise  or  to  develop  any  special  part. 

SWEDISH  MOVEMENT  is,  according  to  Dr.  J.  H.  Kellogg,  a  "system  of 
medical  gymnastics,"  a  "physiological  mode  of  treatment  of  disease."  As 
indicated  by  this  definition,  the  system  consists  largely  of  active  gymnastic 
exercise  upon  the  part  of  the  patient.  Massage,  Dr.  Kellogg  terms  a  spe- 
Mcial  feature  of  the  Swedish  movement.  He  states  the  principle  of  Swedish 
movements,  "that  muscular  movements  are  a  powerful  means  of  affecting 
physiological  processes  and  that  when  gymnastics  are  used  therapeutically, 
they  must  be  employed  with  the  same  accuracy  and  precision  with  which 
the  physician  regulates  the  doses  of  medicinal  agents."  Thus  we  see  that 
the  idea  of  gymnastics  is  made  prominent.  Incidentally,  the  movement 
already  described  as  massage,  and  other  passive  movements  are  used. 
Such  are  hacking,  clapping,  beating,  stroking,  kneading,  fulling,  sawing, 
etc.  A  great  variety  of  movements  are  indicated  and  fully  described,  cer- 
tain, physiological  effects  being  expected  from  a  given  definite  movement. 
Compound  words  are  used,  and  the  terms  read  something  as  follows:  "(i) 
Sitting,  chest-lifting;  (2)  half-lying,  foot-rolling;  (3)  high-ride  sitting, 
trunk-rolling;  (4)  fan-sitting,  arm-rolling,"  etc. 


MASSAGE,  SWEDISH  MOVEMENT  AND  MANUAL  TREATMENT.  291 

The  above  is  taken  from  a  receipt  of  movements  given  for  congestion 
of  the  brain. 

Peter  Henrik  Ling,  the  Swede,  is  credited  with  being  the  originator  of 
a  system  of  Swedish  movements.  A  work  called  Ling's  "System  of  Man- 
ual Treatment"  gives  more  prominence  to  the  manipulations  of  the  opera- 
tor, but  describes  also  active  movements  to  be  made  by  the  patient. 

The  idea  prevalent  among  us  that  massage  does  not  require  a  knowl- 
edge of  anatomy  is  a  mistake. 

These  systems  are  founded  upon  a  most  thorough  knowledge  of  An- 
atomy, Physiology  and  Physical  Diagnosis.  Yet  it  is  probably  true  that 
massage  and  the  like,  as  usually  administered,  are  in  the  hands  of  persons 
who  have  but  a  superficial  knowledge  of  these  sciences. 

These  forms  of  treatment  are  given  in  both  acute  and  chronic  condi- 
tions with  important  results. 

In  Swedish  movements,  motions  are  indicated  for  laxative  effect,  for 
abdominal  disease,  haemorrhoids,  frequent  menstruation,  etc.  A  long  list 
of  receipts  of  combinations  of  motions  is  given  for  such  conditions,  e.  g., 
as  Anemia  and  Chlorosis;  Scrofula,  Diabetes,  Mellitus,  Hysterics,  Tre- 
mors, Colic,  Bright's  Disease,  Pott's  Disease,  Prolapsus  Uteri,  Leucor- 
rhcea,  etc. 

The  effects  of  manual  treatment  are  interesting.  Passive  movements 
act  upon  venous  and  lymphatic  circulation,  and  are  made  in  the  direction 
of  these  currents. 

Stroking  stimulates  the  pilo-motor  nerves,  leads  to  a  contraction  of  the 
arrectores-pili  muscles  which  causes  the  sebacious  follicles  to  be  pressed 
upon,  thus  aiding  secretion. 

By  rubbing,  rolling  and  squeezing  of  the  skin,  the  superficial  circula- 
tion is  stimulated,  the  capillaries  dilated,  and  the  pulse-rate  slowed. 

Firm  kneading  of  the  muscle  is  followed  by  a  slow  pulse  beat,  and  in 
case  a  large  muscular  mass  is  kneaded,  a  fall  of  blood  pressure  in  the  body 
is  noted.  Eccles  states  that  "it  is  possible  that  pain  occurring  in  the  deeper 
organs  may  be  modified  by  manipulation  over  the  superficial  areas  corre- 
sponding to  the  distribution  of  the  cutaneous  sensory  nerves  derived  from 
the  same  segment  of  the  spinal  cord  as  that  from  which  the  sensory  nerves 
of  the  disturbed  viscus  are  derived."  Thus  effects  may  be  gotten  upon  the 
heart  and  lungs  by  external  work.  He  summarizes  the  effects  of  massage 
as  follows : 

1.  "Mechanically  and   directly,   elimination   of  waste  products   from 
the  tissues  under  manipulation  is  increased,  the  absorption  of  exudations 
and  infiltrations  is  greatly  favored,  adhesions  are  attenuated,   sometimes 
broken  down,  and  even  organized  thickenings  may  be  reduced. 

2.  Nutrition  of  the  part  is  improved,  vascularization  is  increased,  and 
metabolism  is  augmented. 


292  MASSAGE,  SWEDISH  MOVEMENT  AND  MANUAL  TREATMENT. 

3.  Indirectly,  massage  acts  as  a  deiivative,  relieving  congestion  of  the 
internal  organs  by  attracting  the  flow  of  blood  to  the  surface,  and  muscular 
vibrations  are  set  up,  stimulating  the  nervous  system,  acting  through  it  re- 
flexly,  thus  exciting  secretion;  while  on  the  other  hand,  its  sedative  influ- 
ence relieves  pain  and  reduces  over  activity." 

Kellgren  claims  for  nerve  vibrations : 

1.  "Raising  of  the  nervous  energy. 

2.  "Diminution  of  pain  [as  seen  in  facial  neuralgia  and  migraine.] 

3.  "Contraction  of  the  smaller  blood-vessels  [heaviness  of  the  head  is 
quickly  relieved  by  stimulation  of  the  sensory  nerves  of  the  scalp.] 

4.  "Stimulation  of  the  muscles  to  contraction. 

5.  "Increased  secretions  of  the  glands. 

6.  "Diminished  excretion  from  the  skin. 

7.  "Decrease  of  temperature  [as  in  fevers.]" 

These  are  given  as  examples  of  results  claimed  for  manual  treatment. 
Much  more  might  be  added. 

Osteopathy  is  not  Massage  or  Swedish  Movements.  While  there  are 
similarities,  there  are  radical  differences : 

i.  These  other  forms  depend  largely  upon  the  general  gymnastic  or 
manipulative  effect  upon  the  body.  Osteopathy  does  not  depend  upon  gen- 
eral effects  from  general  treatments,  but  upon  scientific  treatment. 

•2.  They  emphasize  the  method  of  the  motion  which,  to  the  Osteo- 
path, is  secondary.  A  good  masseur  must  be  an  expert  manipulator  in  the 
particular  sense  of  having  a  knack  to  give  certain  movements. 

3.  They  are  much  more  laborious  and  require  a  much  longer  time  per 
treatment  than  does  Osteopathy.     Sometimes  a  single  motion  is  sufficient 
Osteopathic  treatment,  or  effects  a  cure.  v    • 

4.  Osteopathy  requires  no  gymnastics  of  the  patient  as  a  part  of  the 
treatment. 

5.  They  go  over  the  parts  of  the  body  in  detail,  which  Osteopathy 
does  not  do  except  in  examination. 

6.  They  make  no   search  for  any  lesion  or  abnormality  about  the 
bodily  mechanism,   while  Osteopathy  finds  in  such  lesions,  e.   g.,  a  mis- 
placed part,  the  most  scientific  cause  of  disease. 

7.  They  do  not  go  to  nerve  centers  and  nerve  distributions  in  the 
way  that  Osteopathy  does.     They  work  upon  them  in  a  general  way  and 
only  because  they  are  readily  reached.     They  do  not  seek  for  and  remove 
lesions  therefrom.     On  the  other  hand.    Osteopathy  goes  to   the  definite 
nerve  centers  to  influence  the  health  of  the  body,  and  often  removes  ob- 
structions from  such  centers,  allowing  normal  action.     The  same  is  true 
of  blood  flow. 

In  these  last  two  points  is  seen  the  most  radical  difference  between 
the  systems.  Upon  the  whole,  these  manual  systems  compare  with  Oste- 
opathy as  does  the  shot-gun  with  the  rifle.  They  produce  excellent  results 
by  the  "shot-gun  method"  of  general  manipulation,  while  Osteopathy  works 
with  the  definite  aim  of  finding  the  obstruction  to  health  and  removing  it. 
It  is  unavoidable  that,  if  such  a  comparatively  "hit-and-miss"  method  as 
massage  can  secure  excellent  results  as  a  curative  means,  Osteopathy,  with 
its  definiteness,  must  generally  far  exceed  massage  in  results.  It  also  fol- 
lows that  Osteopathy  must  generally  work  more  quickly  and  easily  than 
massage  in  such  cases  as  the  latter  could  reach,  and  that  it  must  succeed 
in  a  large  class  of  cases  beyond  the  power  of  these  manual  systems,  since 
to  this  class  belong  so  many  disease  conditions  depending  upon  some  re- 
movable obstruction  not  noticed  by  them. 


APPENDIX. 


I.  Much  might  be  said  relative  to  the  proper  examination  of  the 
spine.  Enough  has  already  been  said  to  emphasize  its  importance. 

The  position  of  the  patient  must  be  shifted  during  the  course  of  spinal 
examination,  inasmuch  as  some  lesions,  not  apparent  when  the  patient  is 
sitting,  become  obvious  when  he  lies  upon  his  side,  and  vice  versa. 

In  examining  for  "breaks,"  or  separations  between  the  spinotis  pro- 
cesses, the  patient  must  be  placed  upon  his  side.  The  palmar  surface  of 
the  distal  phalanx  of  the  examining  ringer  may  then  be  passed  carefully 
along  the  spines,  being  held  in  a  position  at  right  angles  to  the  spinal 
column.  The  finger  being  thus  placed  transversely  between  the  successive 
pairs  of  spinous  processes,  can  readily  detect  any  separation  or  approxi- 
mation. 

On  the  other  hand,  slight  lateral  deviations  or  curvatures  of  the  spinal 
column  are  often  masked  when  the  patient  lies  upon  his  side.  These,  and 
all  similar  lesions,  are  best  detected  when  the  patient  is  sitting,  due  care 
having  been  exercised  in  having  him  dispose  both  sides  of  the  body  alike. 
This  is  best  accomplished  by  having  him  sit  upon  the  operating  table  side- 
wise,  in  an  upright  position,  with  the  hands  placed  in  the  same  relative 
position  upon  the  knees. 

In  preference  to  the  method  described  in  the  text  of  passing  the  index 
and  middle  fingers  of  the  examining  hand  down  the  opposite  sides  of  the 
spinous  processes,  the  author  often  uses  the  following :  Both  hands  are 
closed,  leaving  the  index  fingers  protruding.  These  are  now  placed  upon 
the  opposite  sides  of  the  spinous  processes  and  passed  carefully  down  the 
column,  examining  minutely  each  process  in  relation  to  each  other  process 
and  to  the  column  as  a  whole.  Lateral  deviations,  tender  points,  contrac- 
tures,  etc.,  are  thus  readily  detected. 

Equal  care  must  be  exercised  in  examination  of  the  thorax.  One 
valuable  method  in  general  examination  of  the  thorax  is  to  have  the 
patient  lie  upon  his  side,  while  the  palmar  surface  of  the  examining  hand 
is  passed  at  one  sweep  along  line  of  the  angles  of  the  ribs,  from  the 
shoulder  downward  to  the  twelfth  rib. 

With  the  patient  in  the  same  position,  the  inner  or  the  outer  side 
of  the  distal  phalanx  of  the  index,  or  examining,  finger  is  thrust  into 
the  intercostal  spaces,  one  at  a  time,  being  passed  carefully  along  each 
space  to  discover  narrowing  or  widening  thereof. 


294  APPENDIX. 

•2.  A  notable  instance  of  transferred  sensation  was  presented  by  one 
of  my  patients.  She  was  suffering  from  partial  deafness  in  both  ears. 
A  weak  place  was  found  in  the  lower  dorsal  and  upper  lumbar  regions  of 
the  spine.  She  said  that  for  a  long  time  she  had  noticed  that  when  musical 
notes  of  a  certain  pitch  were  struck  in  her  hearing,  she  felt  a  distinct  sharp 
or  tingling  sensation  at  the  weak  point  of  the  spine. 

3.  A  diagnostic  point  of  some  value  is  found  in  the  fact  that  often 
slipped  vertebrae  in  the  lower  cervical   and  upper  lumbar  regions  cause 
rheumatism  in  the  arms.     One  or  several  vertebras  in  these  regions  may 
be  found  luxated,  most  often  laterally ;  contractures  occur  in  some  of  the 
fibres  of  the  supra  spinatus,   rhomboid,  levator  anguli  scapulae,  and  tra- 
pezius  muscles,  and  may  be  traced  from  the  spine  toward  the  shoulder. 
These  contractures,  as  a  rule,  are  sore. 

So  frequently  have  I  found  cases  of  rheumatism  presenting  these 
lesions,  that  I  invariably  look  for  them  in  rheumatism  in  the  upper  ex- 
tremities. On  the  other  hand,  finding  such  has  often  led  me  to  question 
the  patient  in  regard  to  his  liability  to  rheumatism  in  these  members,  with 
the  reply  usually  that  -such  liability  is  present. 

4.  The  Osteopath  is  much  impressed  with  the  force  of  certain  state- 
ments made  by  Simon  Baruch  in  his  "Hydrotherapy,"  as  showing  how 
general  and  valuable  a  field  of  work  the  Osteopath  has  in  working  upon 
the  surface  of  the  body,  thus  attempting  to  influence  the  fluids  and  forces 
of  the  human  system. 

Baruch  states  that  irritation  of  the  cutaneous  surface  is  conveyed 
inward  upon  reflex  tracts  to  the  vessel  walls.  This  goes  to  prove  the 
Osteopath's  contention  that  by  general  manipulation  of  skin  or  muscles, 
by  the  relaxation  of  contractures  in  any  given  set  of  muscles,  or  by  re- 
moval of  superficial  lesion,  he  may  effect  the  state  of  the  vascular  system 
through  these  reflex  tracts. 

We  daily  make  use  of  the  fact  that  the  medulla  is  the  general  vaso- 
motor  center  for  the  system.  Baruch  calls  to  mind  the  fact  that  it  is  the 
center  ruling  the  vaso-motor  supply  of  the  peripheral  vessels,  stating  that 
it  is  probable  that  all  sensory  cutaneous  nerves  congregate  in  the  vaso- 
inotor  center  in  the  medulla,  where  they  connect  with  the  vaso-motor 
nerves  of  all  the  arteries  of  the  body. 

If  such  is  the  fact,  how  easy  it  is  for  the  Osteopath,  by  his  manipula- 
tions, which  are  usually  upon  the  exterior  of  the  body,  to  profoundly 
effect  either  the  general  circulation,  or  the  circulation  of  any  specific  part 
by  the  removal  of  specific  lesion ! 

Further,  he  states  that  the  nerves  supplying  the  Pia  receive  constant 
excitation  from  the  cutaneous  nerves.  This  will  aid  in  explaining  the 
almost  magic  results  we  so  often  attain  in  cases  of  nervousness,  and  in 
cases  of  all  kinds  suffering  from  deficient  nutrition  of  the  whole  or  parts 


APPENDIX.  295 

of  the  nervous  system.  Cases  that  do  not  come  under  this  category  are 
very  few. 

Finally,  the  author  we  quote  says  that  results  obtained  through  cu- 
taneous stimulation  by  various  hydrotherapeutic  procedures  are  not  tran- 
sitory, but  last  several  hours. 

This  certainly  should  be  as  true  of  Osteopathic  results  as  of  those 
gained  by  the  application  of  water,  as  far  as  general  manipulation  goes. 
While  following  the  removal  of  specific  lesions,  they  must  remain  as  per- 
manent results. 

He  states  that  feeble  cutaneous  stimulants  modify  energy  of  cardiac 
contractions  and  increase  their  number,  while  powerful  stimulants  in- 
crease their  force  and  diminish  their  number.  So  the  Osteopath  may 
apply  all  of  these  facts  to  the  explanation  of  the  results  he  may  get  in 
stimulating  or  in  inhibiting  cardiac  action. 

I  have  frequently,  by  stimulation  or  inhibition  of  the  accelerator  fibres 
contained  in  the  upper  three  or  four  dorsal  nerves,  modified  or  increased 
the  heart's  action.  On  the  other  hand,  a  deep,  relaxing,  inhibitive  treat- 
ment of  the  abdomen  will  relax  the  vaso-motors  contained  in  the  various 
sympathetic  abdominal  plexuses,  dilate  the  vast  system  of  abdominal 
veins,  said  to  be  capable  of  accommodating  at  one  time  one-third  of  the 
bulk  of  the  blood  in  the  vascular  system,  call  to  these  abdominal  vessels 
the  blood  from  other  parts  of  the  body,  and  result  in  quieting  the  pulse- 
beat,  or  in  diminishing  the  strength  of  the  radial  pulse. 

These  results  I  have  frequently  gotten  before  my  classes,  having 
several  assistants  counting  the  pulse  in  the  various  stages  of  the  experi- 
ments. By  use  of  these  facts,  important  results  may  be  gotten  in  relieving 
congestion  in  various  parts  of  the  body.  I  have,  by  the  abdominal  treat- 
ment, called  the  blood  from  the  head,  and  relieved  headache. 

By  strong  stimulation  of  the  abdominal  plexuses  the  radial  pulse  may 
be  increased. 

5.  A  case  in  which  the  lesions  were  posterior  and  lateral  prominence 
of    the    fourth    and    fifth    dorsal    vertebrae,    complained    of    a    feeling    of 
irritation  the  length  of  the  oesophagus,  and  distress  of  the  stomach,  par- 
ticularly upon  eating  certain  articles  of  diet,   such  as  strawberries.     Cor- 
rection of  the  lesion  was  followed  by  immediate  relief,  but,  as  that  portion 
of  the  spine  was  weak,   recurrence  of  the  lesion  caused  a  return  of  the 
trouble.    Relief  was  always  felt  upon  correcting  the  condition  of  the  spine. 

6.  In  a  few  cases  I  have  known  of  direct  treatment  upon  lymphatic 
glands,  not  themselves  involved   in   the   disease,   to  give  relief  from  the 
symptoms.     An  Osteopath  claimed  good  results  from  direct  stimulation  of 
the  axillary  lymphatics  in  case  of  a  sore  throat.    Another  claimed  marked 
results  in  a  case  of  obesity  by  treating  the  glands  directly,  in  the  axilla, 
groin,  popliteal  space,  etc. 


296  APPENDIX. 

7.  The  following  rule  is  given  for  locating  the  great  and  small  occi- 
pital and  the  great  auricular  nerves :     Take  the  middle  point  of  the  pos- 
terior edge  of  the  mastoid  process,  measuring  thence  upon  a  line  at  right 
angles  thereto,  and  projected  toward  the  back  of  the  neck,  a  distance  of 
about  one  inch,  brings  the  operating  finger  to  the  particular  point  in  the 
sub-occipital   fossa   where   deep  pressure  best  effects   these  three  nerves. 
Strong  pressure  upon  them  causes  a  pain  to  run  over  the  top  of  the  head 
to  the  eye. 

8.  The  supra-orbital  branches  of  the  fifth  nerve  run  from  the  supra- 
orbital  notches  back  toward  the  temples,  forming  an  angle  of  about  forty 
degrees  with  the  line  of  the  superciliary  ridges.     They  may  be  easily  felt 
beneath  the  tissues,  and  can  be  traced  back  as  far  as  the  temples.     By 
friction  over  them,   together  with  loosening  of  the   tissues  about   them, 
an  operator  may  get  an  important  influence  in  relief  of  headache  or  facial 
neuralgia. 

In  the  same  way,  Ling  points  out  that  one  may  relax  the  tissues  along 
the  mid-line  of  the  skull,  over  the  longitudinal  sinus,  down  to  the  occi- 
pital protuberance,  thence  out  along  the  lateral  sinuses.  This  will  influence 
cranial  circulation,  and  is  valuable  in  treatment  of  headaches,  etc. 

9.  In  examination  of  the  eye  some  simple  methods,  as  pointed  out  by 
Wood,  are  of  much  assistance.     If  a  motion  as  of  striking  the  patient  in 
the  face  causes  winking  (winking  reflex),  it  shows  integrity  of  both  the 
optic  and  facial  nerves,  they  both  coming  into  play  in  seeing  the  motion 
and  in  causing  the  muscles  to  contract. 

In  the  same  way  the  conjunctival  reflex  shows  the  integrity  of  the 
fifth  and  facial  nerves.  It  is  elicited  by  touching  the  conjunctiva  with 
some  soft  object,  such  as  a  camel's-hair  pencil.  The  reflex  is  intact  if 
the  touch  rouses  sensation  and  causes  a  shrinking  of  the  muscles  of  the 
eyelid. 

When  one  is  unable  to  see  an  object  directly  in  front  of  the  eyes 
it  indicates  blindness  in  the  central  fibres  of  the  chiasm.  Hemianopsia, 
or  blindness  in  part  of  the  eye,  indicates  blindness  in  the  fibres  of  the 
chiasm  opposite  to  the  side  of  the  eye  affected,  e.  g.,  blindness  in  the  right 
half  of  the  eye  shows  defect  in  the  left  fibres  of  the  chiasm.  By  placing 
objects  in  the  same  relative  position  with  respect  to  the  eyes,  hemianopsia 
may  be  diagnosed.  Thus,  if  the  patient  is  placed  in  a  recumbent  position 
upon  the  table,  with  his  eyes  fixed  upon  some  object  directly  above  him, 
while  the  operator  gradually  and  equally  raises  his  hands,  one  on  either 
side  of  the  head,  should  the  right  hand  come  into  view  of  the  corres- 
ponding eye  before  the  left,  the  indication  would  be  that  hemianopsia  was 
affecting  the  inner  fibres  of  the  chiasm  pertaining  to  the  left  eye,  causing 
blindness  in  the  outer  half  of  the  eye. 


APPENDIX.  297 

In  several  cases  of  hemianopsia  which  I  have  treated,  vision  improved 
rapidly. 

10.  Lesion  of  the  atlas,  second  or  third  cervical  vertebra?,  may  affect 
either  sight  or  hearing.     I  have  noted  that  in  many  cases  the  eye  or  ear 
on  the  side  opposite  to  that  toward  which  the  vertebra;  were  directed  was 
the  sufferer.     While  this  cannot  be  stated  as  a  rule,  it  has  been  true  in  the 
majority  of  such  cases  coming  to  my  notice. 

11.  Ling  points  out  that  the   seventh  cranial   nerve  is  best  exposed 
to  manipulation  at  the  point   about   midway   of  the   outer   surface   of   the 
ramus  of  the  inferior  maxillary  bone.     Here  it  crosses  the  bone  horizon- 
tally, and  pressure  brought  to  bear  transversely  to  its  course  can't  fail  to 
impinge  upon  it. 

12.  See  Appendix  2. 

13.  In   examination  of  the  intercostal   spaces   one   is   likely   to  find, 
in  cases  of  approximation  of  ribs,  a  tender  point  at  the  sternal  end,  one  at 
the  spinal  end,  and  a  third  about  midway.     The  reason  for  this  is  seen  in 
the  anatomy  of  the  intercostal  nerve,  which  gives  off  a  cutaneous  sensory 
branch  at  each  of  these  points. 

14.  In  examination  of  the  first  rib,   its  sternal  end  may  be  felt  just 
below  the  sternal  end  of  the  clavicle.     At  this  place  the  rib  may  be  traced 
almost  an  inch,  in  many  cases,  until  lost  beneath  the  clavicle. 

By  deep  pressure  above  and  behind  the  clavicle,  the  rib  is  first  felt 
at  about  the  junction  of  the  inner  and  middle  thirds  of  the  clavicle. 
Thence  it  may  be  traced  well  back  below  the  trapezius  muscle  at  the  back 
of  the  neck.  Here  it  is  lost.  Its  head  cannot  be  felt  in  the  human  sub- 
ject, but  deep  pressure  may  be  brought  to  bear  upon  it  by  carefully  finding 
the  seventh  cervical  spine,  and  by  measuring  out  a  full  inch  to  the  side 
of  this  spine. 

In  the  same  way  deep  pressure  is  brought  upon  the  head  of  the  sec- 
ond rib  by  measuring  one  inch  outwards  from  the  first  dorsal  spine,  the 
head  being  masked  by  the  thick  muscles  at  the  back  of  the  neck. 

A  depression  at  the  junction  of  the  end  of  the  first  rib  with  the  stern- 
um usually  indicates  that  this  rib  is  raised,  and  thus  drawn  away  from 
its  articulation.  A  prominence  at  the  same  place  indicates  the  reverse. 
Such  points  are  often  tender  to  the  touch,  and  the  tenderness  may  extend 
along  the  rib  as  far  as  the  clavicle. 

The  first  and  second  intercostal  spaces  are  often  broader  than  the 
others,  and  one  must  sometimes  look  lower  than  he  would  expect,  to 
find  the  sternal  end  of  the  second  rib.  But  all  liability  to  error  is  usually 
removed  by  bearing  in  mind  that  the  junction  of  the  manubrium  with  the 
gladiolus  is  the  landmark  for  the  second  rib. 

15.  See  Appendix  6. 


298  APPENDIX. 

16.  In   deep    abdominal   manipulation  great  care  should  be  used  to 
avoid  violence.     With  this  precaution  one  may  work  deeply,  with  the  flat 
of  the  palm,  in  the  iliac  fossae.     One  hand  may  be  laid  flat  upon  the  abdo- 
men over  the  fossa,  while  the  other  hand  presses  the  first  deeply  in.    This 
gives  one  a  check  upon  the  degree  of  force  used,  and  leaves  the  lower  hand 
freer  to  exert  sense  of  touch  in  examination.     Deep  pressure  with  the  heel 
of  the  palm  in  one  fossa,  and  upwards  along  the  ascending  colon,  while 
the  fingers  reach  across  to  the  other  side,  working  deeply  upon  the  descend- 
ing colon  and  sigmoid  flexure,  is  a  very  efficient  motion  in  treating  for 
constipation. 

The  liver  may  be  thoroughly  stimulated  if,  with  the  patient  upon 
the  back  and  the  operator  standing  beside  him,  the  palms  of 
the  operating  hands  are  placed  over  the  seventh,  eighth,  ninth, 
and  tenth  ribs  on  either  side.  Now  deep  pressure,  without  violence,  may 
be  exerted,  pressing  the  ribs  down  upon  the  subjacent  viscera,  while  the 
hands  are  gradually  approximated :  thus  the  blood  is  pressed  out  of  the 
vessels  in  the  lower  and  other  viscera,  returning  as  the  pressure  is  re- 
laxed. Repetition  of  this  motion  most  effectually  squeezes  the  liver. 
Moreover,  this  lower  costal  treatment  undoubtedly  first  excites,  then  fa- 
tigues the  diaphragm,  relaxing  it  and  freeing  all  the  important  structures 
passing  through  it :  the  vena  cava,  oesophagus,  sympathetic  nerves,  aorta, 
thoracic  duct,  etc.  This  fact  would  have  its  bearing  upon  heart  troubles 
and  other  affections. 

17.  In   work   upon   bowel    troubles,   constipation,    etc.,    the   operator 
should  examine  particularly  the  caecum,  sigmoid  flexure,   and  transverse 
colon. 

The  sigmoid  is  readily  felt  in  the  left  iliac  fossa,  the  upper  curve  of 
the  "s"  lying  about  even  with,  or  a  little  below,  the  anterior  superior  spine 
of  the  ilium.  In  some  patients,  especially  when  the  bowel  is  full,  its  shape 
is  distinctly  felt. 

The  caecum  lies  deeply  in  the  right  iliac  fossa,  and  can  commonly  be 
made  out  there  if  due  care  is  used.  It  is  often  made  evident  by  its  soft 
contents,  which  give  it  the  sense,  under  the  fingers,  of  a  yielding  mass.  It 
is  found  with  more  difficulty  than  is  the  sigmoid  flexure. 

The  transverse  colon  is  usually  detected  by  careful  examination  at  the 
outer  edges  of  the  recti  muscles,  upon  a  level  with  the  umbilicus.  The 
examiner  must  not  forget  the  tendency  of  the  colon  to  be  affected  by 
ptosis,  hence  must  expect  often  to  find  it  below  that  point.  In  such  cases 
one  must  consider  the  probability  of  kinking  through  dragging  at  the 
splenic  and  hepatic  flexures. 

In  individuals  subject  to  intestinal  cramps,  or  colic,  frequently  pressure 
upon  the  sigmoid,  caecum,  ascending,  or  descending  colon,  will  cause  a 
painful  sensation  in  some  other  portion  of  the  bowel. 


APPENDIX,  299 

Deep  abdominal  treatment  may  be  made  to  stimulate  the  receptaculum 
chyli,  lymphatic  duct,  the  sympathetic  plexuses,  the  lumbar  plexus,  and 
all  parts  below  the  diaphragm. 

It  is  a  well  known  fact  that  the  jolting  of  a  wagon  or  of  a  railroad 
train  hinders  the  perestaltic  action  of  the  intestines,  and  may  cause  consti- 
pation. In  our  treatment  for  constipation,  therefore,  care  must  be  taken 
not  to  hinder  the  vermicular  intestinal  motion  by  a  quick  stimulating 
treatment.  A  vibratory,  stimulating  treatment  may  well  be  applied  in 
case  of  diarrhoea. 

18.  A  case  is  reported  in  which  the  patient,  sick  from  an  overloaded 
stomach,  was  caused  to  vomit  by  deep  pressure  applied  between  the  fourth 
and  fifth  ribs  on  the  right  side,   while  the  right  arm   was  elevated  high 
above  the  shoulder. 

In  a  case  of  a  young  child,  sick  from  eating  too  freely  of  an  unsuitable 
diet,  ordinary  manipulation  of  the  abdomen  caused  immediate  vomiting. 

19.  See  Appendix,  17. 

20.  In  a  certain  case  of  constipation,  due  to  a  paralytic  state  of  the 
bowels  accompanying  a  spinal  cord  disease  in  which  there  was  a  partial 
paralysis  of  the  lower  limbs,   steady  treatment  for  ten  months  was  with 
but  little  apparent  effect.     The  bowels  never  moved  without  the  use  of  an 
anema.     At  times  the  motion  was  more  free  than   usual  after  an  anema, 
and   this   unusual    freedom    was    attributed    to    the   treatment.     Within   a 
month  of  the  time  at  which  treatment  ceased,  however,  the  bowels  became 
regular,  remaining  so  for  a  period  of  ten  days.     I  have  had  no  further  re- 
port of  the  case.     Such  a  result  well  illustrates  the  fact  so  often  claimed 
for    Osteopathic    treatment,    that    the    upbuilding    process  is  continued  by 
Nature,  even  after  treatment  ceases.     It  is  well   said  that  our  cures  are 
permanent  because  they  are  natural. 


INDEX 


I. 


ABDOMEN,    auscultation  ..........  174 

considerations  of  ............  154  seq. 

contents  of  ...................  170  seq. 

examination  ......................  171 

landmarks  ....................  158,  167 

measurements  of  .................  175 

nerve  centers,  connections  .....  156 

region  .............................  168 

to   treat  ........................  165,  17  i 

tumor,  cause  of  ..................  156 

ABDOMINAL  BRAIN  ..............    10 

ABORTION,    stimulation   of   nip- 

pies    .....  ;  .......................  201 

ABSCESS,    to  absorb  ...............    59 

ANEMIA  ............................    y2 

iiow   produced  ....................    G7 

mucous   membranes  .............  112 

venous  hum  in  jug.  vein  .......    76 

ANEURISM,   of  aorta  ..........  159,170 

ANGINA  PECTORIS,  cause  cla.v- 

icle  displaced  ...................  148 

ANKYLOSIS,  ligamentous  .........    83 

prevented    ........................    83 

ANTRUM    OP    HIGHMORE,    to 

tap    ..............................  122 

ANUS,  sphincter  ....................    10 

AORTA,  arch,  position  .............  133 

bifurcation  .......................  159 

location  ...........................    13 

sound  is  heard  ...................  139 

APOPLEXY,   treatment  of  ........  219 

ARM,    dislocation   of  ................  202 

vaso-motors  to  ...................     7 

ARTERIES,  axillary  ............  136,  203 

common  carotid  ..................    81 

coronary    .........................  118 

femoral    ..........  ,  ................  205 

gluteal  ............................  182 

innominate  .....  ..133 


internal    mammary  ..............  136 

occipital   ..........................  110 

ovarian   ...........................  195 

perforating  location  .............  137 

posterior   auricular  ..............  110 

pudic  ..............................  382 

.        renal   ..............................    13 

spermatic    ........................  195 

sub-clavian    ......................    84 

supra-orbital    ....................  110 

temporal  ..............  ........  110,  117 

ASTHMA,  case  rapid  heart  beat..  147 
condition  found  in  ...............  135 

frequent  treatment  ..............  99 

ATLAS    ...............................    41 

case   of   paralysis  .............  19,    20 

cause   of  trouble  .........  19,111,117 

disease   of  .........................    3!) 

in  ear   trouble  ....................  i24 

lateral  displacement  of  .........    42 

location    of  ........................     7 

to  tieat  ............................  10* 

AUSCULTATION,    of   chest  .......  140 

of  heart  ...........................  I49 

BACK,  to  examine  ..................    32 

BACTERIAL  FEVER,  treatment 

for  ...........................  2-3,  224 

BARBER'S  ITCH,  treatment  ......  220 

BLADDER,  center  for  neck  .......      9 

motor  fibres  to  ...................  158 

peritoneum    ......................  160 

position   .......................  160,  171 

position   in   over  distension  —  171 
sphincter   .........................  ]57 

sphincter,    to    relax    and    con- 
tract    ............................  393 

to  raise  ............................  194 

treatment   .  ....  194 


INDEX. 


BLOOD  SUPPLY,  aftectSng\nfcf*$ 

life .......    63 

BLOOD   VESSELS,    by   removing 

.lesions    58 

nerves  to J2 

to   affect 44 

under  nerve  control 6t 

BOWELS,   peristalsis   11 

to   move   quickly..     222 

BRAIN,    abdominal 10,    31 

blood  supply  affected 19 

cervical   10 

pelvic    10 

to  affect 10 

BREAKS,   5th   lumbar 7 

32th   dorsal 7 

BRIGHT' S   DISEASE,   considera- 
tion   of 217,  218 

treatment  of 218 

BRONCHI    6, 

irritation  of  161 

BRONCHITIS,  caused  by  clavicle, 

1,  2,  3  ribs..... 150 


CARTILAGE,  costal  displaced....  142 

cricoid 77 

thyroid    77 

CATARACT,  treatment  of 197 

CATARRH,     tenderness    at    jaw 

angle  77 

to  treat  jaw 93 

treatment  of 1U7 

CENTER,  blood"  supply  to  ovaries    10 

for  bowel 184 

for  cervix  uteri 10 

v&so-motor  to  bowels 11 

va so-motor  to  jejunum 10 

va&o-motor  to   kidneys 10 

•vase-motor  to  large  intestine..    10 

vaso-motor  to  larynx 11 

vase-motor  to  liver 10 

vaso-n.'otor  to  lov/er  limbs —    10 

vaso-motor  to  lungs 10 

vaso-motor  to  ?mall  intestine..    10 

vaso-motor  to  spleen 10 

valves  of  heart 10 

CENTERS,  anemia  of C7 

ciliary    i) 

cilio-spinal   10 

description    of 8 

face  and  head 120 

for   chills...  9 


for    cougn 10 

for   defecation 9 

for    deglutition 10 

for  hypogastric  plexus 9 

for   liver 9 

for    lungs 9,  130 

for   micturition 9 

for  neck  of  bladder 9 

for  parturition 9 

for    phonation 10 

for  pyloric  orifice 9 

for    respiration 10 

for  salivation 10 

for  sneeze 10 

for  stomach 0 

for  superficial  fascia 10 

for  vomit 10 

heart  :) 

hyperemia   of 68 

important    — 11 

of  abdomen 156 

of    motion 10 

of  nutrition 10 

of    sensation 10 

peritoneal  to  kidney 164 

renal   10 

spasm  10 

sympathetic    8 

theory  by  Lawrence  Hart 63 

theory  of  work  on 

42,  43,  49,  55,  60.  63,  71,   79,    88 
to    dilate    iris     and    contract 

pupil    9 

to  relax  vagina 30 

vaso-motor    9 

CERVICAL,  brain 10 

disease    (Hilton) 23,    24 

CERVICAL  NERVES,   origin 6 

upper,   lesion   of 21,    22 

CHEMICALS,  abnormal  effect....    45 

CHEST,  barrel  shape 1S5 

divisions    of 1.38 

examination  of 139 

flattening  of 141 

Movement    of 139 

note  the  shape 130 

rachitic1   1?5 

CHILL,  treat  lungs  and  heart —  212 

CHILLS  AND  FEVER,  treat 212 

CHOLERA,   treatment  of 217 

CHOREA,    case    of 75 

causes    76 

lesion    found 75 


INDEX. 


303 


CLAVICLE,   cause  of  bronchitis.  150 
examine    ..........................  135 

to   set  ..............................  143 

to  treat  ............................    S3 

COCCYX,  cause  of  diarrhoea  ......  185 

cause  of  piles  ....................    14 

cause  of  trouble  .................    39 

dislocation  of  ......  ...............    61 

to    set  ............................  Cl,  62 

<?OELIAC   AXIS  .....................      i> 

COLD    FEET  ......................  43,  222 

COLD,  LIVER  ......................  135 

COLIC,   treatment  of  ...............  22° 

COLON,  fecal  reservoir  ...........  ISO 

flexures,    displaced  ...............  173 

transverse,  position  ..............  1 

COMPLEXION    .....................  nl 

CONGESTION   OF   LUNGS  .......  150 

to  relieve  ..........................  131 

CONSTIPATION,    cause  .........  17,  170 

treatment  by  mind,  case  .......  109 

CONTRACTURES,  causes  of...  73,    74 
effect  of  .........................  W,    7 

how  to  recognize  .................    73 

relation  to  nutrition  ............    74 

CONVULSION,  cause  of  ...........  221 

CORACOID   PROCESS,    fibres   of 

deltoid  below  ...................  13~> 

CORRESPONDENCE  of  vertebra 

and  scapula  .....................     fi 

of  vertebra  and  ribs  .............      C 

COUGH,   center  ......................    10 

treatment    for  ....................  21 

CRAMP,  in  feet  .....................  206 

in  intestine,  how  to  treat  ......  183 

piar.ist's    ..........................    2i} 

violinist's  .........................    2 

writer's   ...........................    - 

CRUTCH,  paralysis  ..  ...........  23,  204 

CURVATURE,  cause  of  trouble..    13 
post  (Pott's)   .....................    8i 

to    set  ...........................  42,    61 


DEAFNESS,    case   cured  .......  123,  125 

cause   of    .........................  123 

DEGENERATION,    Wallerian....    90 

DEGLUTITION,   center  for  .......    10 

DESENSITIZATION    ..............     33 

Osteopathic  definition  of  .......    37 

DIAGNOSIS  .........................      5 

by  telephone  .....................      5 

correct   .  .............    24 


Osteopathic  28 

DIAPHRAGM,  central  tendon 

of  13 

phrenic  distribution  in 103 

stoppage  of  aorta 147 

trouble,  cause  28 

DIARRHOEA    IV 

case  cured   184 

cause    17,  184 

to  treat   98,  184 

DIPHTHERIA,    lesion    in 213 

treatment  of  213 

DISEASE  5 

cervical    23 

Graves   H8 

of  spine,  origin   19,    25 

Pott's    , 82 

DISLOCATION,  ankle  205 

arin    202 

elbow  203 

elbow,  reduction  of  203 

hip,   case   of 24,    57 

hip,  dorsal   207 

hip,   indications  by  toes 206 

hip,   obturator    207 

knee  206 

of  vertebra,  to  reduce  41 

DORSAL  NERVES,   origin  of....      6 
6th    and    7th    cause    of    trou- 
ble   25,    30 

DR.  STILL,  centers  spoken  of....    10 

"engine  wipers"    105 

on  ligraments    191 

superficial  fascia  12 

treatment  of  clavicle 143,  144 

DRUGS,   abnormal   effects 45 

DUCT,  Wharton  121 

DUODENUM,  location  of 13 

DYSPEPSIA,    cause  of 57 

E 

EAR    5 

ache,  cause  22 

appearance  if  inflamed 124 

blood  supply  to  treat 125 

cause  of  trouble  cured 125 

external    123 

how  to  remove  substances 124 

insects  to  remove 124 

middle    '..  124 

nerve   supply    22 

to  affect  10 

to  examine  123 

to  test   ..124 


804 


INDEX. 


to  treat  124 

to   treat   125 

trouble  caused  by  atlas Ill 

ECZEMA,  treatment  of 221 

ELECTRICITY,  abnormal  effects    46 
EMPHYSEMA,  condition  of  chest  135 

EPILEPSY,   cause  of 48 

EPISTAXIS,  how  cured 61,    88 

treatment  for  209 

ERECTOR  SPIKAE   6 

ERYSIPELAS    5 

ESOPHAGUS,      perforates      dia- 
phragm        13 

position  in  thorax 133 

superior  opening  of 77 

EXAMINATION,     how     to     pro- 
ceed with   

EXPRESSION   Ill 

EYE,  blood-shot,   to  treat 114 

brilliance  118 

d-ill  118 

indicator  of  disease  112 

landmarks  concerning  121 

lids  granulated  118 

Osteopathic  points  113 

puncta  lacrymalia  121 

to  affect  10 

to  examine  112,  118 

to  treat  114,  118 

vaso-motors    114 

EYELTDS,         granulations        of, 

causes   of   .,  ..214 


FACE    5,  in 

a  disease  indicator  Ill 

FAINTING,  from  overheating....  213 
treatment  for   208 

FALLOPIAN  TUBE,  crowded  by 

obesity 196 

FASCIA,  center  for  12 

superficial  circulation  to 10 

FEET,    cold    48 

cramp,  to  treat  206 

to  treat  205 

FEVER,    importance    of    sympa- 
thetic        12 

treatment  by  poisons  223 

treatment   for   151,  211 

treat  vagus  211 

FLUX,   case  cured 216 

treatment  for  216 

FOMENTATIONS   ..  .44 


FONTANELLE,  anterior 110 

significance  110 

FONTICULUS,  Gutturis  102,105 

to  reach  phrenic 102 

G 

GALL  BLADDER,  location  of....  169 
work  upon   178 

GALL  DUCT,  catarrh  of 178 

location  of  178 

GALL  STONES,  formation 178 

to  remove  169 

treat  spleen  165 

GANGLION,       cervical      sympa- 
thetic      103 

ciliary    114 

connection  with  splanchnic —  128 

first  thoracic  86 

Gasserian  115 

inferior  cervical    86,  103 

inferior  mesenteric,  to -reach..  186 

Meckel's  to  treat  93 

middle  cervical   9,  86,  103 

1,  2,  3,  4  connection  9- 

semi-lunar    128 

stellate   147 

superior  cervical  9,  10,  86,  103 

superior  cervical  connection. 28,    30 

GASTRITIS,  soreness  found 26 

GENITAL,  external  nerves       179,  180 

internal,   center  for.., 195 

internal  nerves    179 

irritation,  reflex  (case  by  Hil- 
ton)      180 

stimulation,   affect  eye 117 

trouble  40,  179 

GIDDINESS,  cause  of 34 

GLANDS,   lymphatic   78,  94,  154 

meibomian    112,  118 

meibomHn,    cause    granulated 

lid    214 

parotid    120 

parotid  enlarged,  to  treat  211 

prostate,  secretory  fibers 158 

sublingual,   enlarged,   to   treat  211 

submaxillary    120 

submnxillary,       enlarged,       to 

treat   211 

thyroid,  enlarged  in  goitre 191 

GLOSSO-PHARYNGEAL,         exit 

from  skull   78 

fibers  to  parotid 120 

GOITRE,  exophthalmic  89 

to  -treat  94,  210 


GRANULATED  EYELIDS,  cause 

of  214 

treatment  of  214 

GRIP,  to  treat  209 


HYPERAESTHESIA,  cause  of...  25 
to  treat  for 69 

HYPERBMIA,  caused  by  nerves  84 

how  produced  88 

of  cord  ..  .66 


HART'S  THEORY  63 

criticised    64 

HAY  FEVER,  cause  of.... 150,  151,  219 
treatment  of  219 

HEAD  109 

cold  in,  how  to  treat 131 

tumors  of   110 

vaso-constrictors  10 

vaso-motors    10 

HEADACHE    7 

from  prolapsus  131 

uterine,  cause   31 

treat    98,  104 

HEART,  action  of,  too  slow 221 

auscultation  of   149 

centers    10,  145 

displaced  ribs,  effect 145 

enlarged  by  cigarettes 134 

examination   of    147 

nutter  9 

irregular  beat  215 

irregularity  from  stomach 163 

neuralgia  of,  treatment  for....  219 

nerve  connection  145 

outline  on  chest  wall 137 

percussion  of  149 

rhythm  of   11 

to  treat  nerves 101,  162 

treatment  of  161,  162 

trouble,  cause  is 

trouble  caused  by  ribs 86 

upper  level  of 13 

valves,  location   of 136 

HEMORRHAGE,     post     partum, 
treatment  for   201 

HEMORRHOIDS,  cause  of 167 

HERNIA,  femoral 181 

inguinal  1*1 

HICCOUGH,  to  treat  for. . .  .76,  85,     j 

HIP,  dislocation  of,  case 24,    58 

dislocations  of   207 

HIP  JOINT,  disease,  to  examine 

for  1«2 

HODDEN    6 

H YDROCEPH ALUS  110 

HYOID,   bone   77 

muscles,  causing   76 


ILIUM,  crest  of 6,  13 

INFLAMMATION  79,  80,  81 

to  treat  44 

INFLUENZA,  to  treat  209 

INHIBITION  36,  43,  49 

effect  95,  98,  99 

INJURIES,  cause  of  trouble 21 

INNOMINATES,  displacement  of, 

189,  190 
treatment     of     displacements, 

190,  191 
INSPECTION,  of  abdomen 172 

of  chest   140 

INSOMNIA,   how   to   treat 22* 

INTERCOSTAL  SPACES 6,  14C 

INTESTINE,  biliary  action  184 

contracted    72 

cramps  in 183 

ganglia    166 

large,  location  of 170 

parasites   of    223 

small,   location   of 170 

stimulation      of      pneumogas- 

tric   183 

stimulation  of  sympathetic —  183 

troubles,  cause 18 

vaso-motor   164 

IRIS,  centers  for 8 

constrictor  center  116 

dilator  fibers,   origin 115 

reflex,     to    obtain.. 112 

sphincter   113 


JAW,  dislocation,  causing 112,  117 

in    eye    troubles 117 

muscles  to   stretch P3 

spasm,    to    feed 122 

JUGULAR  FORAMEN 78 

JUGULAR  VEIN 76 

K 

KIDNEYS  5,  6,      8 

Bright's   disease   of 217,218 

excessive  action  of 218 

indications  of  disease 1?7 

location    of 14,  170 


306 


pelvis  of 13 

peritoneal  center 164,  187 

reached  6 

treatment   of    187 

trouble,    cause 19,  187 

vaso-motor  164,  187 


iJA  GRIPPE,  to  treat 209 

LA:\D:,;ARKS   ALONG  SPINE. 

6,    13 

concerning  abdomen 15S 

concerning'  eye   121 

concerning  head  109,  117 

concerning   neck    76,    84 

concerning   thorax 132,  136 

pelvis    180 

scapular  32 

LARYNGOTOMY  77 

LARYNX,   percussion  over 150 

vaso-motors  to  11 

LEGS,    treat    204 

UEUCORRHOEA  198 

LESIONS,  affects  what 21,    22 

as  a  contracture 74 

as  bad  blood 81 

at  5th  lumbar,  cause  of  geni- 
tal   trouble 179 

at  2d   lumbar,    cause   of  geni- 
tal trouble 179 

by  pressure  89,    91 

caused  by  draft  11 

caused  by  ligaments 8,    11 

caused  by  sprain 11 

caused  by  vertebrae 11 

in  brain  cause  contracture 74 

of  rib  causing 29 

often  found 18 

remove  gradually 100 

remove  result   5G 

significant  in  neck 86 

upper  cervical  22,    23 

LIGAMENT,  condition  in  slipped 

vertebra   : 41 

contracted  broad,  of  uterus 200 

round,  of  uterus 200 

stretching  .    55 

thickening,    cause    16 

Y-shaped,  of  hip 207 

LIGAMENTUM.  in  headache  ....    54 

nuchae  7,    55 

to  treat  54 

LINEA,  alba   158 

labialis  of  disease ..  122 


nasalis  indicative  of  d'sease...  122 

semilunaris    159 

transversa  159 

LIPS,    indicate 121 

LIVER    5,    13 

blood  supply  177 

center    for    9 

cirrhosis,  caput  medusae  173 

cirrhosis,   cause   79 

consideration    of 177 

enlarged  169 

enormous  weight  169 

location   of    169 

nerve   supply    177 

pain   under   scapula 146 

peritoneal   center   177,  178 

position  100 

tender  in  diarrhoea  177 

treatment   of   134,  167 

vaso-motor  supply   164 

LOCOMOTOR  ATAXIA,  to  treat, 

221,  222 

LUMBAGO,    treatment   for 219 

LUMBAR   NERVES,   origin   of...      6 

LUNG,   apex  position 84 

case  treated  40 

center  to  9,  39,  129,  145 

congestion,   to  treat 150 

gases  formed  151 

lower  lobe  location 13 

nerve  connections  145 

outline  on  chest 137 

part  most  liable  to  disease 13 

percussion    of    149 

treatment   145 

trouble,  cause  18.  28,    86 

vaso-motors  to  9,    10 

vessels  constricted   147 

vessels  dilated  147 

LYMPH,  flow  influenced 155 

LYMPHATIC  DUCT,  stoppage  of  155 
LYMPHATIC    GLANDS,    consid- 
eration  of 154 

enlarged  78 

nerves  of  155 

to   treat    .  .    94 


M 


MAMMAE,    treatment    of 160 

MEASLES,  treatment  of 221 

with    whooping   cough 154 

MEDIAN  FURROW 6 

MEDIAN  LINE   ..  .76 


INDEX. 


307 


MENINGITIS,  cause  of 220 

treatment    of 220 

MENSTRUATION,  profuse,  treat- 
ment for    201 

MICTURITION,   frequent  in  pro- 
lapsus      1S7 

MILK  LEG.   cause 208 

MOTION,  center  10 

loss  of 47 

MOUTH,    nurses'    sore    mouth —  209 

sore  mouth   in  mother 209 

sore  mouth,    treatment   for —  209 

MUSCLES,   about  coccyx,   to   re- 
lax        62 

biceps,    contracted 204 

caution    71 

coccygeus    181,  200 

contracted,  result 37,  39,    64 

deltoid   135 

deltoid  fibers  caught 204 

deltoid  pain 34 

erector  spinae    ^33 

flabby  76 

glutei   182 

hyoid,  cause  of  trouble 77 

of  thigh,  to  relax 205 

of  throat   77,    92 

omo-hyoid    83 

on  left  contracted 66 

on  right  contracted 66 

pectoralis  major  .*••  133 

primary    11,    74 

psoas,  how  to  reach 70 

psoas   magnus    134 

pyriformis  in  sciatica 97,  104 

quadratus  lumborum — 85,  152,  192 
quadratus  lumborum,  to  stretch  85 
quadriceps  extensor,  to  stretch  204 

secondary    11,    75 

serratus    magnus 133 

scaleni,   significance 86 

scaleni,   to  stretch 70,104 

scapular,  to  stretch 70 

spinal  congested  11,    16 

sterno-mastoid    84,  102 

tension   in 16 

tonus    72,    76 

to    treat    32,  40,    41 

trapezius  outlined  32 

welt  .  73 


NAUSEA,    between    4th    and    5th 

ribs    176 


XKCK,   care  in  stretching 218 

to  examine    76,  84,    85 

to  manipulate 9,  92,  102,  103 

to  reach  other  organs 77 

NERVE,   action  effected  in  three 

ways   61 

centers   9,  10,    11 

llth  exit  "S 

5th,    how  reached 26,111 

force  effected  44,  50,    61 

force  inhibited  39,    46 

force  misdirected  16,    17 

force  stimulated    39,    46 

impulses  reorganized  31 

9th    exit    78 

phrenic  78,  105,  106 

roots,   emergence  of 25,    26 

section  result  : 50 

sub-occipital    ...„ 86,  102 

10th  exit  78 

trophic  connection    —    76 

ulnar  affected  by  rib 89 

NERVES,  accelerator  fibres 146 

all  reached  by  0 49 

anterior   crural    205 

auditory,  to  inhibit 126 

cervical  connection 28 

connections   156 

dorsal  6  and  7,  cause  of  trou- 
ble    25,    30 

facial  exit H8 

fifth   H5 

5  lumbar,   4th   group 29 

5    sacral,    5th    group,    diseases 

of  20 

lower  auricle,  2d  group 28 

lumbar  diseases  30 

of  heart,   to   treat IPO 

of    "Wrisberg 116 

optic,  to  shock 117 

phrenic,  origin  of 9 

piieumogastric    150 

pressure  upon 89,    9 

pudic,   to  impinge  upon 193 

pudie,    to    locate 132 

pulmonary    vaso-constrictors..  147 

sacral,  distribution   158 

sciatic,   stimulation   of 147 

sciatic,    to  reach 181 

sciatic,   to  stretch 200  seq. 

sheath  in  degeneration 90 

splanchnics  ;  —      9 

sup-laryngeal   irritated 161 

terminals  to  reach 1U 


308 


INDEX. 


third  us 

12  dorsal,  3rd  group 28 

upper  auricle,  1st  group 22 

vaso-motor  9 

viscero-constrictors  129 

viscero-dilators  129 

NEURALGIA,  case  of  5th  nerve..  100 

5th  group  of  nerves 29 

intercostal,  cause 29 

lumbar  29,  30 

of  heart 219 

treatment  220 

NEURASTHENIA  53 

cause  3:j 

NIPPLE,  location  of 133 

stimulation  of,  in  abortio.n 201 

NOSE,  bleed,  to  check 2<w 

deflection  of 12.3 

fractures  ...v 125 

growths  in 125 

to  clear  out 125 

to  examine 125 

to  treat 125 

NOSH  BLEED,  how  stopped ei 

NURSE'S  SORE   MOUTH 209 

NUTRITION,  center 10 

O 

OBESITY,  crowding  ovary ]96 

treatment  for 155 

OCCIPUT   HO 

OSTEOPATHY,  adaptability 57 

diagnosis  28,  58 

how  we  get  results 37 

in  gastritis 27 

?n  paralysis 26 

physiological  37,  38 

points  on  the  eye 113 

reasoning  16, 17,  18, 19,  20,  25,  35 

work  through  N.  terminals....  75 

OVARY,  blood  supply  to 10 

center  for  blood  supply 195 

location 195 

seat  of  1  umor ' 197 

treatment  195 


PAIN,  cause  in  face  and  head 22 

diagnosis    by 25,    30 

in  heart  trouble 146 

in  knee,  in  hip,  trouble 108 

in  lumbar  region  191 

in  stomach  on  pressure 173 


in  the  hip ]91 

in   the  leg 191 

in  the  sacral  region 191 

treat  to  cause 96 

under  icapula 146 

PALPATION  OF  CHEST 139 

PANCREAS,  location  of 13,  170 

PARALYSIS,   cause 23 

caused  by  grippe 1% 

crutch  23,  201 

PARASITE,  intestinal  to  treat....  223 
PARTURITION,    hip    dislocation 

in  203 

PELVIC,  aortic 145 

brain   10 

cardiac    145 

trouble,   cause 40 

viscera  ._. 40 

vis-.cera,  how  to  treat 197 

PELVIS,    consolidations 159 

how  to  treat 189 

pylorus  13 

PERCUSSION,  of  chest 139 

of   heart 143 

PERINEUM,  boundary 181 

shape  of 131 

to  cause  contraction  of 181 

PERITONITIS,  cause  of 91 

condition  of 179 

PHARYNX,  protrusion  in  disloca- 
tion        53 

PHONATION,   center  of ^0 

PHRENIC   NERVE 84 

connections   105 

origin    9 

trouble   in 23 

pressure  causes 36 

to   treat 102,  103 

PHYSIOGNOMY  122 

PILES,  cause  of 14,  167 

PLEURA,  trouble  cause 29 

PLEXUS,  anterior  pulmonary 9 

Auerbach's,    location   of 165 

Billroth's  168 

brachial    28,    87 

cervical  87 

great  prevertebral Ho 

hepatic    167 

hypo-gastric    9,   31,179 

importance    of    primary    and 

secondary   12 

Meissner's  90,  163 

Melssner's,  location  of 1.65 


INDEX. 


309 


posterior    9 

primary    ]2 

renal  1^8 

sacral  19 

secondary   ]2 

solar    57 

solar,  connection  of 156 

solar,  in  headache 131 

solar,  pressure  condenses  gas.  176 

to  bladder Jl 

to  intestinal  canal 11 

to  vasa  deferentia 11 

PNEUMOGASTRIC,       cause       of 

asthma   150 

PNEUMOGASTRIC  NERVE,  con- 
nection with  the  5th  nerve..    42 

exit  from  skull 73 

left  9 

location    81 

Stimulation  of 147 

sympathy  m  dist.   of  5th  and 

10th    60 

to  treat 79 

treat  in  (ever 212 

treatment    of 96 

PNEUMONIA,    treatment  of 215 

POTT'S    DISEASE 82 

PREGNANCY,  simulated  by  gas  198 

PROLAPSUS  131 

PROSTATE  GLAND,   enlarged... 

194,  202 

secretory   fibers 158 

to  reduce 202 

PULSE,  always  note 148 

PYLORIC  ORIFICE,  center  for..      9 

Q 

QUOTATIONS: 

Allen,  Dr.,  contracture,  defini- 
tion      72 

cause  of  contracture 74 

Dana,  applied  electricity 38 

Eckley,  Dr.,  sciatica 3S 

Emerson    5 

Flint,  on  splanchnics 129 

Gaskell,    by   Quain 12S 

Gower's  Flabby  Muscle 76 

Nervous  System,  66,  72,  73,  74,  75 

Green's    Pathology.... 44,  50,  80,  81 

Hart,    Lawrence,    Theory 63 

criticised    64,  65 

Hildreth,  Treatment  and  Diag- 
nosis  .,                       58 


Contractions  of  Spinal  Men- 
ingitis   66,    67 

Hilton    19,  20,  25,    30 

Cervical  Disease  23 

Ear,    Nerves    to 22,  88,  107,  108 

liolden     6,    32 

Howell,   Nerve   Irritability 

Renal  Constriction   45 

Text  Book.. 45,  46,  50,69,  73,  74,  131 

Hulett,  Dr.  C.  M.  T 43,    59 

Huxley    5 

Jacobson,    Dr 108 

Case    of    Child,    bean    in    its 

ear  60 

Reflex  Sensation 60 

Kirk,  Muscle  Tonus 73 

Vaso-motors  Leave  Cord 67 

Lombard,    Dr 38 

Physiology  38 

McConnell,    Dr 43 

Correct  Lesions 59 

Porter,     Dr.     AV.     T.,     M.     D., 
Physiology  38 

Quain 2,   81,   82,   86,  146 

Robinson,  Byron,  89,  !»1,  115,  117,  129 

Abdominal  Brain 31,    90 

Sympathies   68 

Still,    Dr.    Harry 43 

R 

RAMI,  communicantes 12,  13,  128 

distribution    13 

nerves  to  genital  organs 179 

origin    12 

RECEPTACULUM  CHYLI,  loca- 
tion of  13 

controlled  by  splanchnics 155 

RECTUM,  examination  201,  202 

nerves  supply   158 

prolapsed    202 

REFLEX  ACTION  60 

knee,  to  get C6 

REGIONS,  clavicular 128 

hypogastric   168 

epigastric  1C8 

inferior  sternal  138 

infra  clavicular  138 

infra  scapular  138 

inter  scapular  138 

lumbar  191,  193 

mammary   138 

of   back    191 

sacral   193 

scapular  136 


310 


IMDEX. 


sternal    138 

superior  sternal  138 

supra   clavicular 138 

supra  scapular  138 

supra  sternal  138 

umbilical   168 

RENAL   ARTERY 13 

center  10 

colic,  treatment  of 188 

splanchnic,  to  treat 134 

trouble,  cause  18 

RESPIRATION,    center 10 

RETINA,   affected  by   sup.   cerv. 

ganglion    10 

vaso-motors    116 

RHEUMATISM,       articular,       to 

treat   203 

muscular,  to  treat 216 

to  absorb  deposits 59 

treatment  of   216 

RIB.  cartilage  displaced  from 142 

displaced,  to  examine  for 141 

displacement    of   1st    and   2d..  142 

1st  may  cause 9 

1st  and  2d  may  cause 85,  86,    87 

1st  and  2d  preparatory  to  set- 
ting        70 

1st  and  2d,  to  set.. 151,  152 

last    7 

lesions  in  causing 29 

location  of   132,  133 

rules  to  count 133 

sternal   ends   of 133 

tenderness  along   142 

3d  and  5th  displaced 145 

to  raise 151 

twisted   .  ..142 


SACRUM,   abnormal   14 

ant.  or  post. . ... 62 

to  set  .7 62 

SALIVARY  GLAND,  to  affect....  10 
sup.  cervical  ganglion,  connec- 
tions   10 

SALIVATION,   center   10 

SAPHENOUS,  opening 208 

vein,    to   treat 208 

SCAPULA,  location 32 

SCAPULAR,  inf,  angle 6 

spine  6 

SCAR  TISSUE -. 60 

cause  of  trouble...               60 


SCIATICA  11,  18,    46 

cause  , 97,  156,  157 

treatment  for   206 

vaso-motor    37 

SEASICKNESS,    to    treat 221 

SENSATION,  center  10 

loss  of  47 

SHOULDER,  deltoid  fibers  caught  201 

dislocation  203 

SINUS,  frontal 110 

SNEEZE    10 

SORE  SPOTS  

5,  8,  26,  27,  39,  40,  67,  86.  191 

basis  of   8 

success    5 

to  what  due 27 

SPACE,  axillary  139 

ilio-costal  6 

infra-axillary   139 

intercostal    6 

popliteal  205 

second  intercostal  136 

sub-clavicular    136 

3rd  left  intercostal  to  produce 

vomiting  221 

SPASM,  center  for  10 

5th  group  of  nerves 29 

SPHINCTER,  ani,  center  for 10 

ani,   contraction,   cause 17 

of  bladder    157 

of  bladder,  to  relax  and  con- 
tract      193 

rectal    dilatation 148 

relaxation  of   17 

SPINAL,  accessory  nerve  76 

SPINAL  CORD,  sclerosis  of 80 

termination  of  13 

SPINAL  NE5RVES,  origin 6 

SPINE,  condition  on  examination    11 

curves,   abnormal   18,  19,    61 

curves,  result   19 

disease  of,  origin  19 

disease,  to  diagnose  by  pain..    25 

examination  of   7,  11,  14,    32 

general  consideration  of 6 

illustrations  upon 7 

landmarks  6,    13 

noises   along   ....15,19,21,32,42,    70 

smooth    8,17,52,    55 

smooth,  cause  of 62 

to  set  42,    61 

to  treat  32,  39,  47,  51,  61,    69 

SPINES,  approximated  to  treat..    51 
parts  opposite 13 


INDEX. 


311 


posterior,  to  treat  54 

separated,  cause  of 17 

separated,   result    17 

separated,  to  treat 47 

twisted,  result   18 

SPLANCHNIC,  nerves,  great 

9,  12  (,  145 

small    9,  128,  134 

smallest  9,  128 

connections    ., 115 

connections  with  medulla 130 

equalize  circulation  69,  130 

much  treated  127 

pelvic    12S 

renal  to  treat 134 

to  affect  viscera 134 

SPLEEN,  congested   165 

enlarged  170 

location   170 

treat  for  gall  stones 17f> 

treatment  of  186,  23) 

upper  margin  of 13 

vaso-motors  of  164 

SPRAIN,  treatment  of 217 

STERNUM  133 

end  of  133 

2nd  rib  with 133 

STIMULATION   38,46,    49 

effect   95,    97 

STOMACH,     cardiac     orifice     op- 
posite     13,  169 

center  9 

changes  position  168 

interference  with  center 16 

location    144 

nerve  supply  163 

pain  on  pressure 173 

sick,  reflex  176 

to  free  of  its  contents 176 

trouble,  cause   18,    40 

trouble,  causing  welts 75 

trouble,   exercises  in 108 

STRABISMUS,  treatment  of 214 

SUPRA  RENAL  CAPSULES 13 

SURFACE    OF    BODY,     hollows 

upon    6 

SYMPATHETIC  CENTERS  ...12,    13 

connection  to  C.  S 11,12,    27 

distribution    centrally    12 

peripherally  12 

pilo-motor  fibers  12 

secretory  fibers   12 

significance  of  12 

stimulation  in  neck...  ..  147 


sup-cervical  ganglion   9,28,    29 

system    12 

to  affect  distribution   of 32 

SYNCHON'DIR  OS-IS,  sacro-iliac. . . . 

181,  182 

SWEAT  GLANDS,  nerves  to 12 


TEMPERATURE,      changes      on 

surface    87 

of  neck  87 

THEORY   5 

Hart's    63 

of  fever  211 

of   stretching  ligaments 55 

osteopathic    35 

to  affect  internal  viscera 35 

work  on  centers 

49,  56,  60,  63,  72,  79,    88 

THORACIC     DUCT,     obstruction 

of   154 

THORAX,  landmarks  of 132 

succussion  of  160 

sup.   aperture  of 133 

to   examine    134,  138,  139 

treatment   of    134 

THROAT    77 

to  examine  122 

to  treat   92,  126 

THYROID  CARTILAGE   77 

gland    77,  78,  211 

TONGUE,  depressor   122 

furred  on  one  side 126 

to  affect  10 

to  examine  '.  121 

vaso  constrictor  .,1 

vaso   dilator    107 

TONSIL    77 

location   122 

size  12^ 

TOOTHACHE,  to  treat 223 

TRACHEA,    bifurcation    of 13,133 

TRAPEZIUS,   muscle   67 

outlined    32 

TREAT,  between  shoulders   52 

of  cartilages    152 

of  centers    32 

of  ear    125 

of  eye    114,  US 

of  inflammation    44 

of  neck     53,  92,  102,  103 

of  nose   125 

of  spine   

32,  33,  39,  47,  51,  etc.,  61,    69 


312 


INDEX. 


of  throat  126 

straddle    70 

time  taken  41 

to  raise  ribs ' —  152 

too  frequent  99 

TRIANGLE,  Scarpa's  205 

TUBERCULOSIS,   signs  of 139 

TUMOR   89 

abdominal  156 

TYMPANUM,   appearance   123 

appearance,   if  inflamed 124 

TYPHOI-D  FEVER,  treatment  of 
bowels   168 

u 

UMBILICUS,  location  of 13,  159 

URETHRA,   stricture  in 202 

twist  in 201 

URINE,  increased,  by  reading,  in 

hysteria    195 

retention  of 1('5 

UVULA    12G 

UTERINE   CERVIX 193 

displacement,  sympathetic 

troubles    197 

souffle   in  pregnancy 137 

trouble,  cause  and  causing- —    31 

tumor,    causing 21,    57 

UTERUS,  blood  supply 20J) 

broad  ligament 200 

center  10 

center  for  blood  supply 179 

center  for  cervix 10 

congested,   relieved 131 

displaced,  cause  of  headache..  197 

examination  per  vaginam 193 

examine   per   rectum 201 

flexion    197 

ligaments    198 

methods  of  replacing  193 

motor    libers 156 

nerves  to 10 

prolapse  194,  197,  199 

prolapsed    causing1 131 

prolapsus  of  child I'OO 

round    ligament y)0 

to   raise 1'jt,  198 

treatment  in  child 139 

version    197 

V 

VAGINA,  center  to  relax 10 

examine  by  rectum 201 


VASO-CONSTRICTOR    for    head 

10,  101,  102 

VASOCONSTRICTORS  

13,  67,  101,  102 

VASO-D1LATCRS,   origin 13.    67 

VASO-MOTOR  NERVES  9 

effect  by  cold 44 

center  10 

circulation    10 

for    bowels 11  ' 

for  kidneys 10,  164 

for    larynx —    11 

for  liver 10 

for  lower  limbs 10 

for  spleen 10 

for  valves  of  heart 10 

intestine  161 

jejunum    : 20 

of  rabbit's  oar 50 

to  arm 9 

to  large  intestine iO 

to  lungs 9,    10 

to    sciatic 37 

to  small  intestine 10 

VEIN,  abdominal  dilated 131 

ext.  jugular  corresponds 76 

"  location    84 

pulsation   7*5 

facial,   location 317 

innominate  84,  133 

obstruction  of,   in  goitre 210 

saphenous,  treat  after  parturi- 
tion    208 

varicose,    treatment   of 213 

VERTEBRA,  dorsal  spines 6 

11  and  12  dorsal  to  set 47 

1st  and  3rd  cause  eye  trouble.  116 
4th  and  5th  dorsal,  eye  trouble  117 

peculiar 7 

caution    DS 

to  line  up 6 

VOMIT,    center 10 

to   cause 221 

treatment 220,  221 

w 

WALLERIAN  DEGENERATION    90 
\VATER,    cola 45 

hot    41 

WHOOPING     COUGH,      rncas'es 

with     154 

WORMS,   to  destroy... 186 

treatment   for 282 


313 


The  following  index  with  reference  to  the  particular  vertebrae  and 
ribs  is  added  to  assist  not  only  in  diagnosis  but  in  the  treatment  of 
any  abnormal  conditions  found.  For  example:  Should  one  have  a  case 
with  a  lesion  of  the  4th  dorsal,  by  consulting  the  index  under  that 
vertebra  he  would  at  once  be  referred  to  all  that  has  been  said  in  the 
text  as  to  effects  of  such  a  lesion.  The  same  can  be  said  of  any  one  of 
the  vertebrae.  In  other  words,  should  he  not  find  what  he  wanted  in 
the  regular  index  this  special  index  would  be  useful. 


1st   CERVICAL,. 

Atlas    7,    10 

cervical    brain  10 

sensation   10 

larynx U 

articulation  of 30 

effect  the  ear HI 

»       "     eye Ill 

dislocation  of 117 

ear  troubles 124 

effect  the  kidney 157 

2d  CERVICAL. 

sup.  cervical  gangiicn 9 

cervical  brain •_ —  10 

center  for  uterus 10 

larynx    ' H 

articulation  of ^0 

3d  CERVICAL,. 

middle  of  neck 9 

sup.  cervical  ganglion 9 

phrenic,    origin 9 

cervical    brain 10 

rhythm  of  heart 11 

larynx    - —    11 

dislocation  of 11" 

inhibit  auditory  nerve 126 

in  hay  fever 150,  151 

4th  CERVICAL,. 

phrenic,    origin 9 

cervical   brain 10 

rhythm  of  heart 11 

5th  CERVICAL,. 

phrenic,    origin 9 

cervical   brain 10 

c.Uio  spinal  center 10 

ankylosis   20 

level     of     cricoid    cartilage     and 

oceophagus  77 


6th  CERVICAL. 

origin   of  nerves 6 

prominence   of 7 

middle  cervical  ganglion 9 

cervical    brain 10 

ankylosis   20 

level     of.     cricoid    cartilage     and 

oesophagus  71 

7th  CERVICAL. 

prominence    7 

middle  cervical  ganglion 9- 

ant.   branches  to  pulmonary 9 

cervical    brain 10 

apex  of  lung IS 

peculiar   vertebra 18 

ankylosis  20 

transverse  of  process 86 

1st  DORSAL. 

center   to   lungs 9 

ant.  branches  to  pulmonary 3 

cervical  brain 10 

abdominal  brain  10 

heart  center  10 

jejunum  10 

importance  of  18 

hemiphlegia  19 

lateral  dislocation,  to  set 223 

2d  DORSAL. 

center    to    lungs 9,10,130 

ciliary   center    9 

ant.  pulmonary  branches 9 

cervical  brain   10 

abdominal  brain  10 

vaso-motor  center 10 

cilio  spinal  center 10 

heart  center  10 

lower  limbs  10 

circulation  to  superficial  fasciae.. 

10,  12 

valves  of  heart...                         ....  10 


314 


INDEX. 


renal  trouble  IS 

sciatica  18 

lesion    40 

sup.  cervical  ganglion 56 

upper  aperture  of  thorax 133 

lateral  displacement  to  set 223 

3d  DORSAL. 

corresponds  6 

ciliary  center  9 

ant.  branches  to  pulmonary 9 

cervical  brain   10 

abdominal  brain   10 

heart  center 10 

aorta  13 

lung 13 

trachea  14 

sup.  cervical  ganglion,  location  of,  36 

sound  of  aorta  is  heard 139 

4th   DORSAL. 

origin   of  nerves ...' 6 

center  for  stomach 9 

center  for  pyloric  orifice 9 

ant.    branches   to  pulmonary 9 

cervical  brain   10 

abdominal    brain 10 

sensation 10 

motion  10 

cilio  spinal  center 10 

heart  center  10 

valves  of  heart 10 

aorta 13 

heart 13 

trachea  bifurcation  14 

nutrition  center 155 

5th  DORSAL. 

center  for  stomach 9 

center  for  pyloric  orifice 9 

vaso-motors  to  arm 9 

splanchnics   9 

ant.   branches  to  pulmonary 9 

abdominal    brain 10 

heart   center    10 

vaso-constrictors  13 

jejunum 19 

circulation  of  superficial  fascia...  12 

in  hay  fever 150,  151 

6th  DORSAL. 

vaso-motors  to  arm ; 9 

splanchnics    9 

ant.  branches  to  pulmonary 9 

abdominal  brain  10 


nutrition    10 

vaso-motor  centers  10 

vaso-constrictor     10 

kidneys   10 

lesion   16 

corresponds     133 

7th  DORSAL. 

corresponds 6 

splanchnics    9 

ant,   branches   to  pulmonary 9 

abdominal   brain 10 

center  for  lungs 10,  130 

lesion  16,    40 

location  of  mid.  cerv.  ganglion..  S6 
location  of  inf.  cerv.  ganglion..  86 
bounding  space 139 

8th  DORSAL. 

splanchnics    9 

center   for   chills 9 

center  for  liver 9 

ant.  branches  to  pulmonary 9 

abdominal  brain   10 

spleen    10 

heart  13 

diaphragm,    central   tendon 13 

stomach  trouble   16 

spleen,  to  treat —  220 

9th  DORSAL. 

center  for  liver 9 

splanchnic,    small 9 

ant.  branches  to  pulmonary 9 

abdominal   brain 10 

cervix   uteri    10 

peristalsis  of  bowels 11 

spleen,  upper  edge 13 

oesophagus    13 

vena  cava 13 

sound  of,  aorta  is  heard 139 

avoid   in  pregnancy 200 

10th  DORSAL. 

splanchnic,   small 9 

abdominal  brain 10 

pelvic  brain 10 

peristalsis  of  bowels 11 

lung,  lower  edge 13 

liver    13 

stomach  cardiac  orifice 13 

corresponds   133 

in  female  trouble 179 

center  for  ovary 195 


INDEX. 


315 


llth  DORSAL. 

origin   of   nerves 6 

splanchnics,   small 9 

abdominal   brain 10 

blood  supply  to  ovaries 10 

peristalsis  of  bowels 11 

spleen,  lower  edge 13 

supra  renal  capsule 1 

kidney,  location 14 

in  female  trouble 1"9 

center  for  ovary 195 

avoid  in  pregnancy 200 

12th  DORSAL. 

origin   of   nerves P 

corresponds  

methods  to  ascertain  position  of. .  6 

splanchnic,    smallest 9 

abdominal    brain 10 

pleura,  lowest  part 1 

aorta  1 

pylorus    1 

kidney    1* 

separation   liable 18,  47 

lateral    displacement 41 

lumbar   enlargement 09 

spleen    to    treat 220 

1st.  RIB. 

heart   flutter 9,    1* 

heart  center  10 

preparatory  step  to  setting 70 

subclavian  artery  crosses 84 

attachment   of  scaleni  muscles...    86 
location  of  infra  cervical  ganglion    86 

exostosis  of S9 

reach  the  phrenic 105 

found    133 

displaced  upward 143 

cause  trouble  with  heart 147,  161 

in    bronchitis 150 

to  set  151 

lymphatic    obstructions 154,  153 

in  lung  trouble 161 

2d  RIB. 

heart  trouble 18 

preparatory  step  to  setting.. 70 

atta'chment  of  scaleni  muscle SO 

found  133 

edges  of  lung 138 

bounding   spaces 138 

displaced  upward 143 

cause  of  heart  trouble 147,  162 

trouble  with  in  asthma...  ..  150 


in  bronchitis,  to  set 150,  131 

in  lung  trouble 1C1 

3d  RIB. 

bounding    spaces 138 

displaced    145,  133 

in  bronchitis  150 

4th  RIB. 

fourth  133,  138 

displaced    145 

nausea   175,  176 

5th  RIB. 

displaced    145 

in  lung  trouble 162 

nausea   175,  176 

6th  RIB. 

sixth  corresponds 133,  136,138 

bounding    spaces    138 

trouble  with  in  asthma 150 

7th  RIB. 

seventh  rib   136 

cause  of  asthma 18,  150 

corresponds   133 

space   boundary 138 

linea  semilunaris 159 

cardiac  orifice  of  stomach 169 

8th  RIB. 

corresponds  133 

pyloric   orifice   of  stomach 170 

9th  RIB. 

spleen  for  gall  stones 165,  169  17S 

gall  bladder  169.  178 

displaced  in  gas   distension 176 

raise  gently  in  typhoid.. (Part  II)    249 

10th    RIB. 

lower    limit    lung 138 

cartilage   displaced    142 

spleen  for  gall   stones 165,  169,  178 

boundary  of  abdominal  regions...  165 
location   of  spine 168 

llth  RIB. 

eleventh    133 

down    • 143 

spleen   for   gall   stones 165,169,178 

diarrhoea,  184 

flux,    to   treat    216 


316 


INDEX. 


12th  RIB. 

head  of  last  rib 7 

drawn  down   85,  143 

twelfth    133 

bounding  space  138 

diarrhoea   184,  185 

flux,  to  treat 216 

FIRST  LUMBAR. 

origin  of  nerves 6 

abdominal  brain  10 

large  intestine  10 

large   mtdstine    10 

renal  artery   13 

kidney,  pelvis  of 13 

separation  of  47 

lumbar  enlargement  69 

boundary  regions  of  abdomen 170 

SECOND  LUMBAR. 

center  for  parturition 9 

center  for  micturition 9 

center  for  defecation 9 

abdobinal  brain  10 

uterus    10 

kidneys   10 

spinal  cord  13 

pancreas    13 

duodenum   13 

receptaculum  chyli  13 

boundary  of  abdominal  region 168 

spleen 170 

effect  on  bladder 194 

center  for  internal  genitals 195 

avoid  in  pregnancy 200 

THIRD  LUMBAR. 

'  coeliac  axis  9 

abdominal  brain   10 

umbilicus 13 

kidney,    lower  border 13,  14 

FOURTH  LUMBAR. 

corresponds   6 

center  defecation  .  9 


large  intestine    10 

genito-spinal    center    11 

lower  hypogastric  plexus 11 

plexus  to  intestinal  canal 11 

bladder  and  vasa  deferentia 11 

aorta  13 

ilium,  highest  part  13 

FIFTH  LUMBAR. 

center  defecation   9 

center  for  hypogastric  plexus .     9 

pelvic  brain    10 

vaso  motor  center 10 

circulation  to  fascia 10 

genito-spinal  center  11 

lower  hypogastric  plexus 11 

plexus  to  intestinal  canal n 

bladder  and  vasa  deferentia 11 

separation  liable   ig 

lameness    35 

nerve  supply  to  fundus   of  blad- 
der    ^4 

effect  on  bladder 194 

center  for  internal  genitals 195 

avoid  in  pregnancy 200 

treat  for  la  grippe 24) 

SAORUlM. 

center  for  bladder  (neck) 9 

center  to  vulva  and  vagina 9 

center  to   sphincter  ani 10 

lesion    n> 

anterior  and  posterior 62 

lameness 85 

fifth  sacral  in  constipation 55 

COCCYX. 

nutrition    10 

cause  of  .piles  14,    20 

dislocated    61,    62 

cause  of  diarrhoea 185 

CLAVICLE. 

to  reach  phrenic 105 

to  set   .  143 


INDEX. 


PART    II. 


ANKYLOSIS,  caused  by  diseased 

discs   22  3 


CARIES  OP  VERTEBRA 227,  223 

CATARRH    265 

cause  of    26) 

description  of  269 

of  intestines  283 

2d  and  3d  cervical  deviated —  272 

secretions  in  269 

symptoms  of 269 

treatment   271 

CEPHALODYNIA    262 

COLDS    270 

complications  270 

etiology  270 

symptoms  — 270 

treatment   270 

"       particular  method  of..  273 

CONSTIPATION    274 

definition  by  Quain 274 

etiology    275 

local  causes   276 

osteopathic  theory  of 276 

symptoms  275 

treatment   279 

(a)  splanchnic    279 

(b)  over  abdomen  279 

(c)  in  neck  280 

(d)  local    281 

(e)  adjuvant 281 

CROUP    273 

membranous,  .treatment  of 274 

CURVATURES.  (See  Spine.) 

D 

DIARRHOEA,   causes   281 

ettologry  283 

osteopathic  theory  284 

success  in  treating 283 


treatment  of  287 

DIET,  in  typhoid  fever 247,  24S 

DISEASE,  of  invertebral  discs...  227 

Potts'  etiology  of ....229,  230 

of  vertebra   227 

DORSODYNIA  263 

DYSENTERY,    consideration   of.. 

283  seq. 

consideration  of  283  seq. 

etiology  285 

osteopathic  theory  283 

pathology  285 

symptoms   286 

treatment  288,  283 

E 

EFFLEURAGE  283 

EXERCISE,  an  aid 241 

F 

FEVER,  diet  in  typhoid 247,  24S 

etiology  of  typhoid 243,  251 

germ   of   malaria 252 

hemorrhage  in   1 246 

malaria  250 

pathology  of  malaria 252 

perforation  in  typhoid 243 

quartan  253 

quotidian   253 

stages  of  typhoid . .  s 244,  243 

symptomatology  of  malaria. . .  252 

symptoms   of  typhoid 245 

temperature  in  typhoid 246 

tertian  253 

treatment  in  typhoid 248,  249 

treatment  in  malaria 264 

typhoid   243 


H 

HEMORRHAGE,     from 
treatment  for  


bowels, 


318 


INDEX. 


INFLUENZA    266 

clinical  features  267 

etiology    268 

sequelae  '• 268 

symptoms  of 

(1)  catarrhal  type  268 

(2)  thoracic  268 

(3)  gas>tro-intestinal    268 

(4)  cerebral  263 

treatment   270 

varieties  267 

INTERVERTEBRAL  DISCS,   al- 
teration in  shape  and  size...  228 

destruction  of 228 

disease  of 227 


K 


KNEADING   .... 

KYPHOSIS   

pathology  of 


289 
235 
236 


LA  GRIPPE  266 

cerebral  treatment 271 

clinical  features  267 

etiology  263 

liver  treat  in  constipation 280 

sequelae   268 

symptoms  of 

(1)  catarrhal  type  268 

(2)  thoracic  type  26S 

(3)  gastro-intestinal  type  268 

(4)  cerebral  type  268 

treatment   271 

varieties  267 

LORDOSIS    233 

LIGAMENTS     OF    VERTEBRA, 

disease  of  227 

blood  and  nerve  supply 240 

LUMBAGO    '. 262 

cause  of  265 

lesion    265 

M 

MALARIA,  consideration  of 250 

etiology  ; 251 

germ  25} 

pathology  252 

quartan  253 

quotidian  253 

symptomatology  252 

tertian  253 

treatment  254 

MANUAL  TREATMENT  289 


MASSAGE    289 

MYELITIS  230 

MYOCARDITIS,  caused  by  rheu- 
matism    258 

N 

NECROSIS  OF  VERTEBRA 227 


PELVIS,  obliquity  of  233 

PETRISSAGE  289 

PLEURODYNI A    263 

PLEXUS,   Auerbeck's  ruling  mo- 
tion    277 

Meissner's  ruling  secretion 277 

solar  in   constipation 279 

POTT'S  DISEASE,   age  in  which 

occurs    229 

consideration  of  228 

cure,  if  early  treatment 241 

etiology,  constitutional   229 

etiology   of    229 

pathology    229 

symptoms  of  23) 

PNEUMOGASTRIC,  treatment  of  283 

o 

QUOTATIONS,  Quain  229,  274 

R 

RHEUMATIC  FEVER  256,260 

complications  262 

etiology  256 

pathology  261 

symptoms  261 

RHEUMATISM,  acute  articular..  256 

causes  of  256 

cephalodynia  262 

chronic  articular  256,  260 

complications  260 

course  259 

diagnosis  260 

dorsodynia  263 

duration  259 

etiology  256,  262 

muscular  261 

muscular,  lumbago  262 

pathology  257 

pleurodynia  263 

prognosis  260 

rheumatic  fever  269 

symptoms  258,  262 

termination  259 

treatment  263  seq. 

RIBS,  9th,  raise  gently  in  typhoid  249 
10th,  raise  gently  in  typhoid..  249 


INDEX. 


319 


llth,  raise  gently  in  typhoid..  249 

hold  at  the  head  of  in  typhoid.  249 

RUBBING    290 

S 

SOLAR  PLEXUS  IN  CONSTIPA- 
TION     279 

SPINAL  CURVATURES.. 227,  228,  241 
anatomical  characteristics  —  233 
blood  vessels,  interference  with  227 

compensation  232 

etiology  of  232 

exercise  an  aid 241 

hysterical  228,  235 

importance  of  228 

in  whom  found 23J 

kyphosis   228,  235 

lordosis    228,  236 

ligament,  disease  of 227 

muscle,  disease  of 227 

nerves,  interference  with 227 

pathology  of  231 

Pott's  disease' ..228,  241 

scoliosis  228,  232 

spastic  228 

success  in  treating 227 

symptoms  of  231 

treatment   22? 

treatment  of   237 

"         surgically  of  239 

SPINE,  rigid,  troubles  caused  by.  228 
smooth,  troubles  caused  by —  228 

to  spring 239 

treatment  of  223 

tuberculosis  of  229 

SPLEEN,  congested  in  malaria...  25t 

treatment  of ." 254 

STOOLS  IN  TYPHOID 244 

STROKING  289,  290 

SWEDISH  MOVEMENT  ..  ..290 


TAPOTEMENT  239 

TAPPING  289 

THEORY  OF  WORK  IN  CURV- 
ATURES    210 

TREATMENT,  catarrh  267,  271 

colds  271,  273 

constipation  279,  32) 

diarrhoea  287,  23$ 

dysentery    288 


fevers    248,  249,  254,  256 

influenza  271 

la  grippe   271 

lumbago   26:J 

malaria  230 

manual   289 

Pott's  disease  223 

rheumatism  263  seq. 

spinal  curvatures  228 

spine    223 

TUBERCULOSIS  OF  SPINE 229 

TYPHOID  FEVER  243  seq. 

diet  in  247,  248 

etiology    243 

hemorrhage  in  246 

perforation  in  246 

stages  in   244,  245 

symptoms  245 

temperature    246 

treatment  in   248,  249 


INDEX   TO  APPENDIX. 


ATLAS,    results   of   lesion    of 297 

BARUCK,    his    views 294 

CONSTIPATION,    cause   of 299 

CRANIAL    CIRCULATION    296 

CURES,    permanent,     why 299 

EYE    296 

EXAMINATION,    breaks    293 

coecum 298 

eye    296 

intercostal    spaces    297 

sigmoid   flexuro    29S 

spine    293 

thorax    293 

transverse   colon    293 

HEART,    action    modified 295 

HEMIANOPSIA    2% 

LYMPHATICS    295 

MANIPULATION,    abdominal. 298,  299 

first    rib    297 

liver    298 

seventh    cranial    nerve 297 

OBESITY,  case  of 295 

RHEUMATISM,    in    arms 294 

RULE,    for   locating   nerves 296 

SPINE,  correction  of,  brings  relief  295 
TRANSFERRED  SENSATION...  291 
VOMIT,  to  produce 290 


Date  Due 


-ISO- 
CD 


PRINTED  IN   U.S.*.  CAT.     NO.     24      161 


C 


UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY 


A  000  421  781  6 


Hazzard,  Charles. 

Principles  of  osteopathy 


